Provider Demographics
NPI:1659260040
Name:MENDOZA BAUTISTA, ANA BEATRIZ
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:BEATRIZ
Last Name:MENDOZA BAUTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N CHURCH ST APT 15
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-1277
Mailing Address - Country:US
Mailing Address - Phone:209-445-9694
Mailing Address - Fax:
Practice Address - Street 1:412 N CHURCH ST APT 15
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-1277
Practice Address - Country:US
Practice Address - Phone:209-445-9694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)