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General NPI Number Information
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NPI Number | 1194341776
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Entity Type | Individual
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Provider Name | CHRISTIAN JESUS MENDOZA DMD
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Gender | Male
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 11/25/2022
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Provider Practice Location Address
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Address Line | 35952 WINCHESTER RD BLDG 2
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City | WINCHESTER
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State | CA
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Zip | 92596-7537
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Country | US
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Telephone | 888-329-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 ISLAND AVE APT 435
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City | SAN DIEGO
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State | CA
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Zip | 92101-7965
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Country | US
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Telephone | 619-840-5115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | PD0011
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 107354
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License Number State | CA
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