Healthcare Provider Details

I. General information

NPI: 1437844750
Provider Name (Legal Business Name): JENNIFER ALMA MENDOZA CERTIFIED NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W BASELINE RD STE 8
TEMPE AZ
85283-1068
US

IV. Provider business mailing address

1649 S SPARTAN ST
GILBERT AZ
85233-8769
US

V. Phone/Fax

Practice location:
  • Phone: 602-323-0904
  • Fax: 602-812-3559
Mailing address:
  • Phone: 602-819-8582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTEMP289285
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: