Provider Demographics
NPI:1649930181
Name:MENDOZA, MAEGAN MERCY (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MAEGAN
Middle Name:MERCY
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S BERETANIA ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1871
Mailing Address - Country:US
Mailing Address - Phone:407-985-0228
Mailing Address - Fax:
Practice Address - Street 1:1401 S BERETANIA ST STE 102
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1871
Practice Address - Country:US
Practice Address - Phone:407-985-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-25
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
GA390200000X
HIAMD1179363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program