Healthcare Provider Details

I. General information

NPI: 1356141675
Provider Name (Legal Business Name): MARIA MAGDALENA MENDOZA MEDICAL HEALTH CARE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S MARKET ST UNIT 2004
SAN JOSE CA
95113-2876
US

IV. Provider business mailing address

360 S MARKET ST UNIT 2004
SAN JOSE CA
95113-2876
US

V. Phone/Fax

Practice location:
  • Phone: 669-288-8458
  • Fax:
Mailing address:
  • Phone: 669-288-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: