Provider Demographics
NPI:1710536685
Name:MENDOZA, JAIME M
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:M
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 S COUNTY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-6069
Mailing Address - Country:US
Mailing Address - Phone:559-636-8730
Mailing Address - Fax:
Practice Address - Street 1:2616 S COUNTY CENTER DR
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-6069
Practice Address - Country:US
Practice Address - Phone:559-636-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider