Individual
DR. EVELYN MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
301 N SAN JACINTO ST, HEMET, CA 92543-3113
(951) 766-6460
(951) 766-6459
Mailing address
23278 KENT CT, MURRIETA, CA 92562-5086
(951) 461-6653
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A48611
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A486110
—
CA
01
—
05D1062719
CLIA NUMBER
CA
01
—
1225222029
MEDICARE PART B DME
CA
01
—
1457545840
MEDICARE PART B DME
CA
01
—
1558555938
MEDICARE PART B DME
CA
01
—
1962696344
MEDICARE PART B DME
CA
01
—
330643850
TAX INDENTIFICATION NUMBE
CA
01
—
5945420001
MEDICARE PART D DME
CA
01
—
5945420002
MEDICARE PART D DME
CA
01
—
5945420003
MEDICARE PART D DME
CA
01
—
5945420004
MEDICARE PART D DME
CA
Enumeration date
07/05/2005
Last updated
02/05/2009
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