Provider Demographics
NPI:1225179310
Name:MENDOZA, CHERRY ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:ROSE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHERRY
Other - Middle Name:ROSE
Other - Last Name:NERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5630 E SANTA ANA CANYON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3122
Mailing Address - Country:US
Mailing Address - Phone:714-257-6170
Mailing Address - Fax:
Practice Address - Street 1:5630 E SANTA ANA CANYON RD STE 100
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3122
Practice Address - Country:US
Practice Address - Phone:714-257-6170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16129363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical