Provider Demographics
NPI:1700334885
Name:MENDAROS, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MENDAROS
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 1:1630 CONTRA COSTA BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3085
Mailing Address - Country:US
Mailing Address - Phone:925-429-8320
Mailing Address - Fax:925-421-0625
Practice Address - Street 1:1630 CONTRA COSTA BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3085
Practice Address - Country:US
Practice Address - Phone:925-429-8320
Practice Address - Fax:925-421-0625
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide