Provider Demographics
NPI:1952074452
Name:MENDOZA, MILA TRAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MILA
Middle Name:TRAN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:MILA
Other - Middle Name:T
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30141 ANTELOPE RD # D-728
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7001
Mailing Address - Country:US
Mailing Address - Phone:760-560-8036
Mailing Address - Fax:
Practice Address - Street 1:29239 MEANDERING CIR
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7313
Practice Address - Country:US
Practice Address - Phone:951-445-3281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017893363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner