Healthcare Provider Details

I. General information

NPI: 1518891472
Provider Name (Legal Business Name): RAQUEL JOSEFINA MENDOZA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 N WOODLAND AVE
TUCSON AZ
85712-4147
US

IV. Provider business mailing address

1634 N WOODLAND AVE
TUCSON AZ
85712-4147
US

V. Phone/Fax

Practice location:
  • Phone: 520-396-8069
  • Fax:
Mailing address:
  • Phone: 520-396-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026018613
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: