Provider Demographics
NPI:1578004081
Name:MENDOZA, ESMERALDA JOY FLORES (N/A)
Entity Type:Individual
Prefix:
First Name:ESMERALDA JOY
Middle Name:FLORES
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:ESMERALDA JOY
Other - Middle Name:MENDOZA
Other - Last Name:GO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:911 PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3811
Mailing Address - Country:US
Mailing Address - Phone:619-254-4791
Mailing Address - Fax:
Practice Address - Street 1:6061 BANBURY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3624
Practice Address - Country:US
Practice Address - Phone:760-471-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00902629376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide