Provider Demographics
NPI:1316794670
Name:MENDEZ, GENESIS G
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:G
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 N EUCLID AVE SUITE 200B
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6092
Mailing Address - Country:US
Mailing Address - Phone:909-662-9565
Mailing Address - Fax:
Practice Address - Street 1:1430 E LYNWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-7047
Practice Address - Country:US
Practice Address - Phone:909-662-9565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle