Provider Demographics
NPI:1265259600
Name:MENDOZA, JAN ADRIAN IGTANLOC (RN)
Entity type:Individual
Prefix:
First Name:JAN ADRIAN
Middle Name:IGTANLOC
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14729 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2215
Mailing Address - Country:US
Mailing Address - Phone:415-513-9713
Mailing Address - Fax:
Practice Address - Street 1:14729 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2215
Practice Address - Country:US
Practice Address - Phone:415-513-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95267978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse