MEDICARE: MARIA G MENDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1598019945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA G MENDEZ

Provider Business Mailing Address
First Line	:	4117 N TORREY PINES DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108
Country	:	US
Telephone Number	:	559-802-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 N TORREY PINES DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-5538
Country	:	US
Telephone Number	:	559-802-0115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	11/07/2012

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