Provider Demographics
NPI:1376417360
Name:MENDOZA, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SAN FELIPE RD STE 12
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3035
Mailing Address - Country:US
Mailing Address - Phone:669-326-0546
Mailing Address - Fax:
Practice Address - Street 1:321 SAN FELIPE RD STE 12
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3035
Practice Address - Country:US
Practice Address - Phone:669-326-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker