Provider Demographics
NPI:1699594010
Name:MENDOZA HERNANDEZ, YANETH KARINA
Entity type:Individual
Prefix:
First Name:YANETH
Middle Name:KARINA
Last Name:MENDOZA HERNANDEZ
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 1:655 BRIARCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3216
Mailing Address - Country:US
Mailing Address - Phone:408-317-8032
Mailing Address - Fax:
Practice Address - Street 1:655 BRIARCLIFF DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3216
Practice Address - Country:US
Practice Address - Phone:408-317-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031928363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care