Healthcare Provider Details

I. General information

NPI: 1114678406
Provider Name (Legal Business Name): DENISE DIANETTE MENDOZA BSN, RN,PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 ROSSANO CT
SALINAS CA
93905-4918
US

IV. Provider business mailing address

1346 ROSSANO CT
SALINAS CA
93905-4918
US

V. Phone/Fax

Practice location:
  • Phone: 831-206-6799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number95424718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: