Healthcare Provider Details

I. General information

NPI: 1669063798
Provider Name (Legal Business Name): BREEZY MENDOZA NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

IV. Provider business mailing address

10031 W VIA MONTOYA DR
PEORIA AZ
85383-3299
US

V. Phone/Fax

Practice location:
  • Phone: 480-257-6383
  • Fax:
Mailing address:
  • Phone: 480-257-6383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BREEZY MENDOZA
Title or Position: OWNER
Credential: NP
Phone: 480-257-6383