Provider Demographics
NPI:1316196322
Name:MENDOZA, RACHEL MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:217 W CENTRAL AVE STE G
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-2830
Mailing Address - Country:US
Mailing Address - Phone:805-735-4292
Mailing Address - Fax:805-735-4293
Practice Address - Street 1:217 W CENTRAL AVE STE G
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2830
Practice Address - Country:US
Practice Address - Phone:805-735-4292
Practice Address - Fax:805-735-4293
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19915363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1084058OtherTHE NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANT
CA19915OtherCALIFORNIA STATE PHYSICIAN ASSISTANT LICENSE
CAAS196YMedicare PIN