Provider Demographics
NPI:1497508105
Name:MENDOZA, ANGELA RENEE (CCMA, CPT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CCMA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18945 SISKIYOU RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1532
Mailing Address - Country:US
Mailing Address - Phone:760-912-2830
Mailing Address - Fax:
Practice Address - Street 1:12370 HESPERIA RD STE 15
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5808
Practice Address - Country:US
Practice Address - Phone:760-261-5292
Practice Address - Fax:760-269-1296
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other