Provider Demographics
NPI:1790936565
Name:MENDOZA, MARI FAITH FERNAN
Entity Type:Individual
Prefix:
First Name:MARI FAITH
Middle Name:FERNAN
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 1:2046 TOMALES BAY DR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-7933
Mailing Address - Country:US
Mailing Address - Phone:530-838-8803
Mailing Address - Fax:
Practice Address - Street 1:2901 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5224
Practice Address - Country:US
Practice Address - Phone:925-439-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist