Active NPI
Rose Mendiola
- Substance Abuse Rehabilitation Facility
- Vallejo, CA
National Provider Identifier
1417324872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Substance Abuse Rehabilitation Facility
- License
- R36801214
- Practice address
- 130 Stanford Dr
Vallejo, CA 94589-1746 - Phone
- (707) 246-7971
- NPI assigned
- Sep 1, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | R36801214 | CA | Primary |
Addresses
Primary practice location
130 Stanford Dr
Vallejo, CA 94589-1746
Mailing address
130 Stanford Dr
Vallejo, CA 94589-1746
Phone (707) 246-7971
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C0600029 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R36801214 | CA | MD | Substance Abuse Rehabilitation Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441065600000",
"number": "1417324872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 STANFORD DR",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945891746",
"telephone_number": "707-246-7971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 STANFORD DR",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945891746",
"telephone_number": "707-246-7971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDIOLA",
"first_name": "ROSE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-01",
"last_updated": "2015-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "324500000X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility",
"state": "CA",
"license": "R36801214",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "C0600029",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.