Provider Demographics
NPI:1659381416
Name:MENDOZA, JESUS CRUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:CRUZ
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JESS
Other - Middle Name:CRUZ
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16540 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-6218
Mailing Address - Country:US
Mailing Address - Phone:562-947-0944
Mailing Address - Fax:
Practice Address - Street 1:801 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 130
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2628
Practice Address - Country:US
Practice Address - Phone:909-623-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA346292083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine