MEDICARE: KARLA GARCIA MENDOZA BS

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	2355S0801X	Speech-Language Assistant	13688	AZ

General Provider Information

NPI Number	:	1790433639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARLA GARCIA MENDOZA BS

Provider Business Mailing Address
First Line	:	5660 S 12TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-3102
Country	:	US
Telephone Number	:	520-807-9668
Fax Number	:	520-807-9575

Provider Business Practice Location Address
First Line	:	5660 S 12TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85706-3102
Country	:	US
Telephone Number	:	520-807-9668
Fax Number	:	520-807-9575

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

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	03/10/2022

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