Provider Demographics
NPI:1013203140
Name:MENDONCA, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MENDONCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 MENLO AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4745
Mailing Address - Country:US
Mailing Address - Phone:650-752-6346
Mailing Address - Fax:650-752-6342
Practice Address - Street 1:644 MENLO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4745
Practice Address - Country:US
Practice Address - Phone:650-752-6346
Practice Address - Fax:650-752-6342
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program