Healthcare Provider Details

I. General information

NPI: 1144507237
Provider Name (Legal Business Name): VICENTE GABRIEL MONTEIRO MENDES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 02/13/2019
Certification Date: MENDES VICENTE GABRIEL MONTEIRO 43188 CORTE CALANDA TEMECULA CA 92592 34101 FARENHOLT AVE SAN DIEGO CA 92134
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34101 FARENHOLT AVE BUILDING 14
SAN DIEGO CA
92134-7000
US

IV. Provider business mailing address

43188 CORTE CALANDA
TEMECULA CA
92592-3604
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-5544
  • Fax:
Mailing address:
  • Phone: 760-917-3879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: