Provider Demographics
NPI:1497055073
Name:JUAN ANTONIO MENDOZA
Entity Type:Organization
Organization Name:JUAN ANTONIO MENDOZA
Other - Org Name:ABI P&O
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-285-5040
Mailing Address - Street 1:6190 FAIRMOUNT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3428
Mailing Address - Country:US
Mailing Address - Phone:619-285-5040
Mailing Address - Fax:619-285-5045
Practice Address - Street 1:205 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2702
Practice Address - Country:US
Practice Address - Phone:619-425-8189
Practice Address - Fax:619-425-7907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0900XAmbulatory Health Care FacilitiesClinic/CenterAmputee
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center