Provider Demographics
NPI:1508124215
Name:MENDOZA, MELISSA ANTONIA (MS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANTONIA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 PERLITA ST.
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3245
Mailing Address - Country:US
Mailing Address - Phone:909-489-8989
Mailing Address - Fax:
Practice Address - Street 1:3739 PERLITA ST.
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3245
Practice Address - Country:US
Practice Address - Phone:909-489-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program