Provider Demographics
NPI:1841787447
Name:MENDOZA, EDDIE A (CST)
Entity type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:A
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E TAHQUITZ WAY STE A1
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7060
Mailing Address - Country:US
Mailing Address - Phone:760-327-1509
Mailing Address - Fax:760-327-4032
Practice Address - Street 1:1900 E TAHQUITZ CANYON WAY STE A1
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7060
Practice Address - Country:US
Practice Address - Phone:760-327-1509
Practice Address - Fax:760-327-1509
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
97767246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE