Healthcare Provider Details

I. General information

NPI: 1295380004
Provider Name (Legal Business Name): BIANCA ADALID MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 MILTON AVE STE 200B
WESTMINSTER CA
92683-2939
US

IV. Provider business mailing address

2855 PINECREEK DR APT E130
COSTA MESA CA
92626-7402
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 805-616-3431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: