Provider Demographics
NPI:1134701923
Name:MENDOZA, AILEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 PENNYCRESS DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-8242
Mailing Address - Country:US
Mailing Address - Phone:970-556-5184
Mailing Address - Fax:
Practice Address - Street 1:5890 W 13TH ST STE 101
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4821
Practice Address - Country:US
Practice Address - Phone:970-810-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant