Healthcare Provider Details

I. General information

NPI: 1043135783
Provider Name (Legal Business Name): JENNIFER MARIE MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23328 OLIVE WOOD PLAZA DR
MORENO VALLEY CA
92553-5247
US

IV. Provider business mailing address

25879 FLINT DR
MORENO VALLEY CA
92553-4922
US

V. Phone/Fax

Practice location:
  • Phone: 951-455-7497
  • Fax:
Mailing address:
  • Phone: 951-455-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: