Healthcare Provider Details

I. General information

NPI: 1194671859
Provider Name (Legal Business Name): LAISHA VANESSA MENDOZA MELCHOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109C VENTURA AVE
GERBER CA
96035-2163
US

IV. Provider business mailing address

109C VENTURA AVE
GERBER CA
96035-2163
US

V. Phone/Fax

Practice location:
  • Phone: 530-646-6904
  • Fax: 530-646-6904
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number755349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: