Provider Demographics
NPI:1235570524
Name:MENDEZ, LISA ANN (REGISTERED NURSE (RN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE (RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:BOYINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1404 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2988
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1404 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2988
Practice Address - Country:US
Practice Address - Phone:925-642-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439418163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse