Healthcare Provider Details

I. General information

NPI: 1477477404
Provider Name (Legal Business Name): LESLIE DANIELA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 KENYON ST NW APT 207
WASHINGTON DC
20010-2726
US

IV. Provider business mailing address

1636 KENYON ST NW APT 207
WASHINGTON DC
20010-2726
US

V. Phone/Fax

Practice location:
  • Phone: 202-677-8871
  • Fax:
Mailing address:
  • Phone: 202-677-8871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number02130148908
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: