Provider Demographics
NPI:1437181922
Name:MENDEZ, DIEGO (MD)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4282 GENESEE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4964
Mailing Address - Country:US
Mailing Address - Phone:858-268-0300
Mailing Address - Fax:877-409-7359
Practice Address - Street 1:4282 GENESEE AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4964
Practice Address - Country:US
Practice Address - Phone:858-268-0300
Practice Address - Fax:877-409-7359
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47906208D00000X, 207V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A479060Medicaid
CA00A479061Medicaid
CA00A479061Medicaid
CAZZZ27298ZMedicare ID - Type Unspecified