Provider Demographics
NPI:1710452719
Name:MENDOZA, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 SEARS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-4905
Mailing Address - Country:US
Mailing Address - Phone:619-721-4927
Mailing Address - Fax:
Practice Address - Street 1:2220 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-1926
Practice Address - Country:US
Practice Address - Phone:619-972-8983
Practice Address - Fax:619-525-9908
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator