Healthcare Provider Details

I. General information

NPI: 1629557434
Provider Name (Legal Business Name): YOCELIN CECILIA CRUZ MENDOZA I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3469 14TH ST NW
WASHINGTON DC
20010-3405
US

IV. Provider business mailing address

3469 14TH ST NW
WASHINGTON DC
20010-3405
US

V. Phone/Fax

Practice location:
  • Phone: 202-602-7281
  • Fax:
Mailing address:
  • Phone: 202-602-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number2318040
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: