Healthcare Provider Details

I. General information

NPI: 1255033510
Provider Name (Legal Business Name): ANA PALAFOX-MENDEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 W ORANGE AVE STE D
EL CENTRO CA
92243-3274
US

IV. Provider business mailing address

516 W ATEN RD STE 2
IMPERIAL CA
92251-9805
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-8858
  • Fax: 760-545-0248
Mailing address:
  • Phone: 760-355-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: