Provider Demographics
NPI:1427099431
Name:MENDIOLA, LEE (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:MENDIOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6519
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93006-6519
Mailing Address - Country:US
Mailing Address - Phone:805-650-3880
Mailing Address - Fax:805-650-3887
Practice Address - Street 1:1752 S VICTORIA AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6192
Practice Address - Country:US
Practice Address - Phone:805-650-3880
Practice Address - Fax:805-650-3887
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA708602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA70860Medicare ID - Type Unspecified
CAH32995Medicare UPIN