Provider Demographics
NPI:1497900872
Name:MENDEZ MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:MENDEZ MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-324-5275
Mailing Address - Street 1:1420 CRESTMONT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4201
Mailing Address - Country:US
Mailing Address - Phone:661-330-8753
Mailing Address - Fax:661-874-2070
Practice Address - Street 1:1420 CRESTMONT DR
Practice Address - Street 2:SUITE A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4201
Practice Address - Country:US
Practice Address - Phone:661-330-8753
Practice Address - Fax:661-874-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47906207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A479061Medicaid
CAZZZ27298ZMedicare PIN