Juan Carlos Mendoza, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

58384 Issued in CA

Practice address

1430 Truxtun Ave
4TH Floor
Bakersfield, CA 93301-5246

Phone

(661) 635-3050

Fax

(661) 869-1503

NPI assigned

Jun 29, 2009

Last updated

Jun 29, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Clinica Sierra Vista

  dba South Bakersfield Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Bakersfield, CA
  • NPI 1073515425
  NPD (past)
• Clinica Sierra Vista

  dba West Delano Dental Center

  • Federally Qualified Health Center (FQHC)
  • Delano, CA
  • NPI 1134318959
  NPD (past)

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246233600000",
    "number": "1689802621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "441 DIAZ AVE",
            "city": "DELANO",
            "state": "CA",
            "postal_code": "932154121",
            "telephone_number": "559-930-4364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 TRUXTUN AVE",
            "address_2": "4TH FLOOR",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933015246",
            "telephone_number": "661-635-3050",
            "fax_number": "661-869-1503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "JUAN CARLOS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2009-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "58384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Gabriel Mendoza, CRNA
• Diana Mendoza
• Graciela Mendoza, BA
• Ignacio Mendoza
• Jessabel Mendoza
• Julissa Mendoza, SLP
• Kathy Mendoza
• Maira Yasmin Mendoza
• Marcelo Mendoza, MD
• Mariah Ashley Mendoza

• Dentist in Bakersfield, CA
• Providers in Bakersfield, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.