Healthcare Provider Details

I. General information

NPI: 1679205595
Provider Name (Legal Business Name): TULA MARIA MENDOZA PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 SUNRISE AVE
MADERA CA
93638-4926
US

IV. Provider business mailing address

144 E DAYTON AVE
FRESNO CA
93704-4503
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-7893
  • Fax:
Mailing address:
  • Phone: 408-910-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95163872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: