=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790936565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARI FAITH FERNAN MENDOZA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2008
-----------------------------------------------------
Last Update Date | 09/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2901 RAILROAD AVE
-----------------------------------------------------
City | PITTSBURG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94565-5224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-439-8575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2046 TOMALES BAY DR
-----------------------------------------------------
City | BAY POINT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94565-7933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-838-8803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 56688
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------