NPI 1063122208

Primo Gregory Mendez

Practitioner Driver Stockton, CA

Practice location

Address: 1136 Porter Ave, Stockton, CA 95207-4214
Phone: (209) 914-0094

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X

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Registry record

NPI: 1063122208
Entity type: Individual
Sex (as registered): Male
NPI issued: 29 Nov 2022
Record last updated: 29 Nov 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.