Healthcare Provider Details

I. General information

NPI: 1437181922
Provider Name (Legal Business Name): DIEGO MENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE STE 201
SAN DIEGO CA
92117-4964
US

IV. Provider business mailing address

4282 GENESEE AVE STE 201
SAN DIEGO CA
92117-4964
US

V. Phone/Fax

Practice location:
  • Phone: 858-268-0300
  • Fax: 877-409-7359
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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: