Provider Demographics
NPI:1851532766
Name:MENDOZA, IVAN ARMANDO (EMT-P, PSGT)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:ARMANDO
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:EMT-P, PSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W COLE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-9700
Mailing Address - Country:US
Mailing Address - Phone:760-277-2398
Mailing Address - Fax:
Practice Address - Street 1:120 W COLE BLVD STE B
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-9700
Practice Address - Country:US
Practice Address - Phone:760-277-2398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other