Provider Demographics
NPI:1912784562
Name:MENDOZA, CHRISTIAN (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5203
Mailing Address - Country:US
Mailing Address - Phone:813-654-2544
Mailing Address - Fax:813-653-4391
Practice Address - Street 1:109 MARGARET ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5203
Practice Address - Country:US
Practice Address - Phone:813-654-2544
Practice Address - Fax:813-653-4391
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9117793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant