Provider Demographics
NPI:1912784562
Name:MENDOZA, CHRISTIAN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:122 NEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4510
Mailing Address - Country:US
Mailing Address - Phone:908-220-9432
Mailing Address - Fax:
Practice Address - Street 1:4105 49TH ST N STE B
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-5711
Practice Address - Country:US
Practice Address - Phone:727-582-6900
Practice Address - Fax:727-526-4346
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant