Basic Information
| Provider Information | |||||||||
| NPI: | 1659615383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDEZ-FLORES | ||||||||
| FirstName: | KENDY | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3611 S HARBOR BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927046928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097920747 | ||||||||
| FaxNumber: | 9097921057 | ||||||||
| Practice Location | |||||||||
| Address1: | 2930 INLAND EMPIRE BLVD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917644802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099806700 | ||||||||
| FaxNumber: | 9099806003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2012 | ||||||||
| LastUpdateDate: | 11/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | Y | Other Service Providers | Community Health Worker |
No ID Information.