Healthcare Provider Details

I. General information

NPI: 1912606450
Provider Name (Legal Business Name): NUBIA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7615 ORA GLEN DR
GREENBELT MD
20770-3642
US

IV. Provider business mailing address

7615 ORA GLEN DR
GREENBELT MD
20770-3642
US

V. Phone/Fax

Practice location:
  • Phone: 240-650-0811
  • Fax:
Mailing address:
  • Phone: 240-650-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number859585-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406664
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: