Healthcare Provider Details

I. General information

NPI: 1174882450
Provider Name (Legal Business Name): LILIANA AROSEMENA MENDOZA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PARKWAY SUITE 230 PACIFIC PULMONARY MEDICAL GROUP
RIVERSIDE CA
92505
US

IV. Provider business mailing address

4234 RIVERWALK PARKWAY SUITE 230 PACIFIC PULMONARY MEDICAL GROUP
RIVERSIDE CA
92505
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-3672
  • Fax: 951-781-0365
Mailing address:
  • Phone: 951-781-3672
  • Fax: 951-781-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101020967
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A15446
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20A15446
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number20A15446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: