Provider Demographics
NPI:1801459748
Name:MENDOZA, PAULA MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MICHELLE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2083 ARTISAN WAY APT 307
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2598
Mailing Address - Country:US
Mailing Address - Phone:619-863-8452
Mailing Address - Fax:
Practice Address - Street 1:610 EUCLID AVE STE 302
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2953
Practice Address - Country:US
Practice Address - Phone:619-863-8452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily