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General NPI Number Information
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NPI Number | 1558368605
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Entity Type | Individual
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Provider Name | EVELYN MENDOZA M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 02/05/2009
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Provider Practice Location Address
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Address Line | 301 N SAN JACINTO ST
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City | HEMET
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State | CA
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Zip | 92543-3113
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Country | US
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Telephone | 951-766-6460
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Fax | 951-766-6459
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Provider Business Mailing Address
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Address Line | 23278 KENT CT
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City | MURRIETA
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State | CA
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Zip | 92562-5086
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Country | US
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Telephone | 951-461-6653
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | A48611
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License Number State | CA
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