Provider Demographics
NPI:1588949887
Name:MENDOZA, LINDA EVELYN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:EVELYN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5516
Mailing Address - Country:US
Mailing Address - Phone:714-532-7571
Mailing Address - Fax:
Practice Address - Street 1:810 W COLLINS AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5516
Practice Address - Country:US
Practice Address - Phone:714-532-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP20908208000000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP20908OtherCA. BOARD OF NURSING