Healthcare Provider Details

I. General information

NPI: 1417868373
Provider Name (Legal Business Name): JUAN CARLOS MENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 MAIN ST
WATSONVILLE CA
95076-4356
US

IV. Provider business mailing address

341 ECHO VALLEY RD
SALINAS CA
93907-8483
US

V. Phone/Fax

Practice location:
  • Phone: 831-688-8840
  • Fax: 831-688-8302
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: