Provider Demographics
NPI:1871133504
Name:MENDEZ, LINDSEY (FNP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-1926
Mailing Address - Country:US
Mailing Address - Phone:707-725-3334
Mailing Address - Fax:707-725-2455
Practice Address - Street 1:874 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-1926
Practice Address - Country:US
Practice Address - Phone:707-725-3334
Practice Address - Fax:707-725-2455
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95013629OtherFAMILY NURSE PRACTIONER