Healthcare Provider Details

I. General information

NPI: 1427240225
Provider Name (Legal Business Name): VERONICA MENDOZA MEDICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR STE 100
SAN DIEGO CA
92134-1100
US

IV. Provider business mailing address

34800 BOB WILSON DRIVE STE #100
SAN DIEGO CA
92134
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7199
  • Fax: 619-532-6587
Mailing address:
  • Phone: 619-532-7199
  • Fax: 619-532-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: