Provider Demographics
NPI:1942678503
Name:MENDOZA, HECTOR JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:MENDOZA
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-2601
Mailing Address - Country:US
Mailing Address - Phone:909-983-8202
Mailing Address - Fax:909-391-2482
Practice Address - Street 1:1841 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-2601
Practice Address - Country:US
Practice Address - Phone:909-983-8202
Practice Address - Fax:909-391-2482
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist