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General NPI Number Information
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NPI Number | 1073700134
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Entity Type | Organization
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Legal Business Name | MENDOZA FAMILY PRACTICE MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 02/27/2012
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Provider Practice Location Address
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Address Line | 1303 JEFFERSON ST
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City | DELANO
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State | CA
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Zip | 93215-2205
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Country | US
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Telephone | 661-720-9111
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Fax | 661-725-4689
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Provider Business Mailing Address
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Address Line | 1303 JEFFERSON ST
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City | DELANO
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State | CA
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Zip | 93215-2205
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Country | US
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Telephone | 661-720-9111
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Fax | 661-725-4689
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ANNA LUISA MENDOZA
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Credential | M.D.
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Telephone | 661-720-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A88698
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License Number State | CA
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