Provider Demographics
NPI:1245358449
Name:MENDOZA, FERNANDO C (PA, NP)
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:C
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:PA, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2522
Mailing Address - Country:US
Mailing Address - Phone:805-682-9942
Mailing Address - Fax:805-563-9493
Practice Address - Street 1:1704 STATE ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2522
Practice Address - Country:US
Practice Address - Phone:805-682-9942
Practice Address - Fax:805-563-9493
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19277363A00000X
CA17178363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245358449OtherNPI