MEDICARE: HECTOR MENDOZA JR. PHARM.D.

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	183500000X	Pharmacist	73292	CA

General Provider Information

NPI Number	:	1942678503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR MENDOZA JR. PHARM.D.

Provider Business Mailing Address
First Line	:	1841 E 4TH ST
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-2601
Country	:	US
Telephone Number	:	909-983-8202
Fax Number	:	909-391-2482

Provider Business Practice Location Address
First Line	:	1841 E 4TH ST
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-2601
Country	:	US
Telephone Number	:	909-983-8202
Fax Number	:	909-391-2482

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

Provider Enumeration Date	:	09/11/2015
Last Update Date	:	09/11/2015

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