Healthcare Provider Details

I. General information

NPI: 1528277985
Provider Name (Legal Business Name): MRS. MAYRA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6313 W. BROWNING AVE.
FRESNO CA
93723-7663
US

IV. Provider business mailing address

6313 W. BROWNING AVE.
FRESNO CA
93723-7663
US

V. Phone/Fax

Practice location:
  • Phone: 559-277-9379
  • Fax:
Mailing address:
  • Phone: 559-277-9379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number684875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: