Provider Demographics
NPI:1023202108
Name:MENDEZ, JESUS B (PA)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:B
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 NILES ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4246
Mailing Address - Country:US
Mailing Address - Phone:661-324-5075
Mailing Address - Fax:661-324-5220
Practice Address - Street 1:2917 NILES ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4246
Practice Address - Country:US
Practice Address - Phone:661-324-5075
Practice Address - Fax:661-324-5220
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13796363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical