Healthcare Provider Details

I. General information

NPI: 1215109954
Provider Name (Legal Business Name): MENDEZ MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE SUITE 201
SAN DIEGO CA
92117
US

IV. Provider business mailing address

4282 GENESEE AVE SUITE 201
SAN DIEGO CA
92117-4946
US

V. Phone/Fax

Practice location:
  • Phone: 661-330-8753
  • Fax: 858-246-6374
Mailing address:
  • Phone: 858-268-0300
  • Fax: 877-409-7359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA47906
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA47906
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA47906
License Number StateCO

VIII. Authorized Official

Name: DR. DIEGO MENDEZ
Title or Position: PHYSICIAN
Credential: MD
Phone: 858-268-0300