Individual
JOSE LUIS MENDIVIL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3525 PRESLEY AVE, RIVERSIDE, CA 92507-4453
(951) 955-9375
Mailing address
3525 PRESLEY AVE STE 12, RIVERSIDE, CA 92507-4453
(951) 955-9375
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-SNQMUV
CA
Other
Enumeration date
07/25/2024
Last updated
05/14/2025
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