Healthcare Provider Details

I. General information

NPI: 1760407159
Provider Name (Legal Business Name): ESTELA INCLAN MENDEZ L.V.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY SUITE 1100
SACRAMENTO CA
95820
US

IV. Provider business mailing address

7808 17TH AVENUE
SACRAMENTO CA
95820-3606
US

V. Phone/Fax

Practice location:
  • Phone: 916-874-9670
  • Fax: 916-874-9297
Mailing address:
  • Phone: 916-791-8993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN136744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: