Provider Demographics
NPI:1194399287
Name:RADILO-MENDOZA, MARIA DE LA CRUZ
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LA CRUZ
Last Name:RADILO-MENDOZA
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 1:28374 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5072
Mailing Address - Country:US
Mailing Address - Phone:951-961-3822
Mailing Address - Fax:
Practice Address - Street 1:28374 CAMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5072
Practice Address - Country:US
Practice Address - Phone:951-961-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264477164X00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No164X00000XNursing Service ProvidersLicensed Vocational Nurse