Healthcare Provider Details

I. General information

NPI: 1013715481
Provider Name (Legal Business Name): CAROLINA MENDOZA MSN, RNC-OB, C-EFM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

3140 W WASHINGTON BLVD
CHICAGO IL
60612-1841
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4175
  • Fax:
Mailing address:
  • Phone: 773-983-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number041.369628
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: