Healthcare Provider Details

I. General information

NPI: 1295568228
Provider Name (Legal Business Name): CYNTHIA RUBY MENDOZA GARIBAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E 7TH ST
MADERA CA
93638-3780
US

IV. Provider business mailing address

1417 FRESNO ST
MADERA CA
93638-2106
US

V. Phone/Fax

Practice location:
  • Phone: 559-395-0451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number711410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: