MEDICARE: ESMERALDA JOY FLORES MENDOZA N/A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	00902629	CA

General Provider Information

NPI Number	:	1578004081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESMERALDA JOY FLORES MENDOZA N/A

Provider Business Mailing Address
First Line	:	911 PARADISE DR
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-3811
Country	:	US
Telephone Number	:	619-254-4791
Fax Number	:

Provider Business Practice Location Address
First Line	:	6061 BANBURY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-3624
Country	:	US
Telephone Number	:	760-471-0388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2017
Last Update Date	:	03/16/2017

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