Healthcare Provider Details

I. General information

NPI: 1386560571
Provider Name (Legal Business Name): RUBEN MENDOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 INDIAN SCHOOL RD NE STE 240
ALBUQUERQUE NM
87110-4172
US

IV. Provider business mailing address

6121 INDIAN SCHOOL RD NE STE 240
ALBUQUERQUE NM
87110-4172
US

V. Phone/Fax

Practice location:
  • Phone: 505-372-0000
  • Fax: 844-692-2525
Mailing address:
  • Phone: 505-372-0000
  • Fax: 844-692-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number7319
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: