Provider Demographics
NPI:1750049854
Name:MENDEZ MONTOYA, LUIS FERNANDO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:FERNANDO
Last Name:MENDEZ MONTOYA
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 1:3510 SANTIAGO CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9534
Mailing Address - Country:US
Mailing Address - Phone:209-658-3041
Mailing Address - Fax:
Practice Address - Street 1:3510 SANTIAGO CT
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-9534
Practice Address - Country:US
Practice Address - Phone:209-658-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver