Provider Demographics
NPI:1982320305
Name:MENDOZA, SAMANTHA (RD)
Entity type:Individual
Prefix:MISS
First Name:SAMANTHA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:SANTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:10964 RINCON ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-5213
Mailing Address - Country:US
Mailing Address - Phone:951-440-1210
Mailing Address - Fax:
Practice Address - Street 1:10964 RINCON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-5213
Practice Address - Country:US
Practice Address - Phone:951-440-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86088543133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered