Provider Demographics
NPI:1710904214
Name:MENDOZA, ROSALIA ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIA
Middle Name:ALLAN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5140 DIAMOND HEIGHTS BLVD APT 305A
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1766
Mailing Address - Country:US
Mailing Address - Phone:415-401-0109
Mailing Address - Fax:415-282-2102
Practice Address - Street 1:3687 MT DIABLO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3746
Practice Address - Country:US
Practice Address - Phone:925-756-3499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87521207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I51021Medicare UPIN
CA00A875210Medicare PIN