Provider Demographics
NPI:1265943385
Name:MENDOZA, RUEL FRANCIS
Entity type:Individual
Prefix:DR
First Name:RUEL
Middle Name:FRANCIS
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 E MORADA LN APT 7202
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-1656
Mailing Address - Country:US
Mailing Address - Phone:630-518-1759
Mailing Address - Fax:
Practice Address - Street 1:1830 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2163
Practice Address - Country:US
Practice Address - Phone:209-538-4927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist