Individual provider Active NPI

Jennifer Denise Mendoza, FNP

  • Family Nurse Practitioner
  • Santa Rosa, CA
National Provider Identifier
1154057750
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95021956 Issued in CA
Practice address
751 Lombardi CT
Santa Rosa, CA 95407-6798
Phone
(707) 547-2222
NPI assigned
Jul 26, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95021956 CA Primary

Addresses

Primary practice location

751 Lombardi CT
Santa Rosa, CA 95407-6798

Mailing address

209 E 3Rd St Apt 4
Cloverdale, CA 95425-3348
Phone (520) 668-9203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231030002192 CA Practitioner - Nurse Practitioner 3577919497 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95021956CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Santa Rosa Community Health Centers CurrentSince Aug 29, 2023 Accepting new patients
Santa Rosa Community Health Centers CurrentSince Aug 29, 2023 Accepting new patients

Locations

3569 Round Barn Cir
Santa Rosa, CA 95403

751 Lombardi Ct
Ste B
Santa Rosa, CA 95407
Phone (707) 547-2220

751 Lombardi Ct
Santa Rosa, CA 95407
Phone (707) 547-2222

Interoperability endpoints

  • Direct secure messaging: jmendoza627582@direct.ochin.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1154057750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 E 3RD ST APT 4",
            "city": "CLOVERDALE",
            "state": "CA",
            "postal_code": "954253348",
            "telephone_number": "520-668-9203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 LOMBARDI CT",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954076798",
            "telephone_number": "707-547-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "JENNIFER",
        "middle_name": "DENISE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-26",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95021956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.