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ALISA JOSEFINA MENDOZA PA
NPI 1174412910
Physician Assistant in San Bernardino, CA

Active since June 28, 2025PECOS Enrolled
2101 N WATERMAN AVE, SAN BERNARDINO, CA 92404(909) 883-8711 Get Directions Write a Review

NPPES record last updated: December 19, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 19, 2025, Jun 28, 2025 (2 updates tracked since 2025).

About Alisa Josefina Mendoza Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ALISA JOSEFINA MENDOZA PA (NPI 1174412910) is an individual physician assistant in San Bernardino, California, licensed in California (PA67119) and active in the NPI registry since June 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1174412910
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameALISA JOSEFINA MENDOZACredential: PA
Location Address2101 N WATERMAN AVESan Bernardino, CA 92404-4836
Mailing Address12226 Pascal AveGrand Terrace, CA 92313-5426 · (951) 315-1129
Phone(909) 883-8711
Sole ProprietorYes
Medical School CMSOtherGraduated 2025
Enumeration DateJune 28, 2025
Last NPPES UpdateDecember 19, 20252 updates tracked since enumeration
NPPES CertifiedDecember 19, 2025
✔ NPI 1174412910 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in CA · PA67119
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
2101 N WATERMAN AVE, San Bernardino, CA 92404
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Alisa Josefina Mendoza Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID749773877
PECOS Enrollment IDI20251205002654
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92404 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$91.88 typical visit price
range $59.60 – $179.42
Typical copayment $22.97 (range $14.90 – $44.85)
Most-billed visit code 99203
Established Patient
$74.08 typical visit price
range $19.37 – $146.42
Typical copayment $18.52 (range $4.84 – $36.60)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NICHOLAS WALTHER PA-C
Physician Assistant (Medical)
2101 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (909) 883-8711
DR. GIAN CHRISTIAN TONGSON IGNACIO MD
Student in an Organized Health Care Education/Training Program
2101 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (818) 282-2085
FASIHA NAZIR
Student in an Organized Health Care Education/Training Program
2101 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (909) 883-8711
DEVAL DAVE PA
Physician Assistant
2101 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (909) 883-8711
ALYSSA HOGUE
Pharmacy Technician
2101 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (909) 883-8711
DR. ARIN VANESSA COLLIN MD
Student in an Organized Health Care Education/Training Program
2101 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (909) 883-8711
DAVID D. TITO M.D.
Emergency Medicine
2101 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (909) 883-8711
ROBERT DEVORE, JR., M.D., INC
Anesthesiology
2101 N WATERMAN AVE
SAN BERNARDINO, CA 92404
San Bernardino County (800) 883-7243

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Alisa Mendoza's NPI number?

The NPI number for Alisa Mendoza is 1174412910. It was assigned to this individual provider in the NPPES registry on June 28, 2025.

Where is Alisa Mendoza located?

Alisa Mendoza practices at 2101 N Waterman Ave, San Bernardino, CA 92404. The listed phone number is (909) 883-8711.

What is Alisa Mendoza's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Alisa Mendoza enrolled in Medicare?

Yes. Alisa Mendoza is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Alisa Mendoza was last updated on December 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.