Provider Demographics
NPI:1114682663
Name:DIMEN, DENNIS NEAL MENDOZA (FNP-C)
Entity Type:Individual
Prefix:
First Name:DENNIS NEAL
Middle Name:MENDOZA
Last Name:DIMEN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:DENNIS
Other - Middle Name:
Other - Last Name:DIMEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:206 PIERRE DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7855
Mailing Address - Country:US
Mailing Address - Phone:510-754-0965
Mailing Address - Fax:
Practice Address - Street 1:206 PIERRE DR
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7855
Practice Address - Country:US
Practice Address - Phone:510-754-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily