Provider Demographics
NPI:1861670614
Name:MENDOZA, KRISTINA MARIE (AUD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17768 WIKA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1200
Mailing Address - Country:US
Mailing Address - Phone:760-503-1700
Mailing Address - Fax:760-503-1728
Practice Address - Street 1:17768 WIKA RD STE 200
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1200
Practice Address - Country:US
Practice Address - Phone:760-503-1700
Practice Address - Fax:760-503-1728
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1439231H00000X
237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist