Healthcare Provider Details

I. General information

NPI: 1972471811
Provider Name (Legal Business Name): TERESA MARIE MENDEZ RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6378 BUDLONG LAKE AVE
SAN DIEGO CA
92119-3321
US

IV. Provider business mailing address

6378 BUDLONG LAKE AVE
SAN DIEGO CA
92119-3321
US

V. Phone/Fax

Practice location:
  • Phone: 619-248-3704
  • Fax:
Mailing address:
  • Phone: 619-248-3704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number415911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: