Provider Demographics
NPI:1376335117
Name:MENDOZA, JESTER ISAIAH CRUZ (PA)
Entity type:Individual
Prefix:
First Name:JESTER ISAIAH
Middle Name:CRUZ
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:512 BRINWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3089
Mailing Address - Country:US
Mailing Address - Phone:408-594-6891
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:408-594-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant