Provider Demographics
NPI:1215627195
Name:HERNANDEZ MENDOZA, SILVESTRE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SILVESTRE
Middle Name:
Last Name:HERNANDEZ MENDOZA
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18564 US HIGHWAY 18 STE 108
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2320
Mailing Address - Country:US
Mailing Address - Phone:760-946-2112
Mailing Address - Fax:760-946-2113
Practice Address - Street 1:18564 US HIGHWAY 18 STE 108
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2320
Practice Address - Country:US
Practice Address - Phone:760-946-2112
Practice Address - Fax:760-946-2113
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily