Individual
ELLEN MENDOZA CHURCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
130 E SAN FERNANDO ST APT 410, SAN JOSE, CA 95112-7416
(408) 775-1411
Mailing address
130 E SAN FERNANDO ST APT 420, SAN JOSE, CA 95112-7420
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/08/2017
Last updated
02/02/2018
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