Healthcare Provider Details

I. General information

NPI: 1588949887
Provider Name (Legal Business Name): LINDA EVELYN MENDOZA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W COLLINS AVE
ORANGE CA
92867-5516
US

IV. Provider business mailing address

810 W COLLINS AVE
ORANGE CA
92867-5516
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-7571
  • Fax:
Mailing address:
  • Phone: 714-532-7571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNP20908
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP20908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: