Healthcare Provider Details

I. General information

NPI: 1083421077
Provider Name (Legal Business Name): RAQUEL ANNE MENDOZA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAQUEL ANNE STONE

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N WESTERN AVE
NOGALES AZ
85621-2060
US

IV. Provider business mailing address

825 N GRAND AVE STE 100
NOGALES AZ
85621-1061
US

V. Phone/Fax

Practice location:
  • Phone: 520-287-4747
  • Fax: 520-281-4487
Mailing address:
  • Phone: 520-761-2128
  • Fax: 520-281-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF12240190
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number317965
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number317965
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: