Healthcare Provider Details

I. General information

NPI: 1184508905
Provider Name (Legal Business Name): CAROLINA GARDUNO MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 O ST
LINCOLN NE
68510-2235
US

IV. Provider business mailing address

280 PANAMA RD
MARTELL NE
68404-6129
US

V. Phone/Fax

Practice location:
  • Phone: 402-436-1000
  • Fax:
Mailing address:
  • Phone: 402-570-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: