Provider Demographics
NPI:1316074073
Name:PIONEERS MEMORIAL HEALTHCARE DISTRICT
Entity type:Organization
Organization Name:PIONEERS MEMORIAL HEALTHCARE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-351-3333
Mailing Address - Street 1:731 CESAR CHAVEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-2105
Mailing Address - Country:US
Mailing Address - Phone:760-357-4850
Mailing Address - Fax:760-357-6991
Practice Address - Street 1:731 CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2105
Practice Address - Country:US
Practice Address - Phone:760-357-4850
Practice Address - Fax:760-357-6991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255734363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARNP9528OtherRN FURNISHING #
CARN255734OtherRN LICENCE