Provider Information for 1629441639
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JESSICA LISBET MENDOZA-MIRANDA
Sex: Female
NPI: 1629441639
Last Updated: 2024-09-10
Certification Date: 2024-09-10
Certification Date: 2024-09-10
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1629441639 | ||||||||
| Enumeration Date | 2015-11-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 273 TUNIS RD OAKLAND, CA 94603-1061 United States Phone: 510-603-4868 | Fax:877-905-8222 | ||||||||
| Primary Practice Address | 273 TUNIS RD OAKLAND, CA 94603-1061 United States Phone: 510-603-4868 | Fax:877-905-8222 | ||||||||
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