Provider Demographics
NPI:1699742510
Name:MENDOZA, ANNA LUISA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LUISA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1230 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2204
Mailing Address - Country:US
Mailing Address - Phone:661-428-2991
Mailing Address - Fax:661-725-0595
Practice Address - Street 1:1230 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2204
Practice Address - Country:US
Practice Address - Phone:661-428-2991
Practice Address - Fax:661-725-0595
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA88698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699742510Medicaid
CA1699742510Medicaid
CAI22815Medicare UPIN