Healthcare Provider Details

I. General information

NPI: 1629490560
Provider Name (Legal Business Name): YURI G MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E CLINTON ST
HOBBS NM
88240-8238
US

IV. Provider business mailing address

315 E CLINTON ST
HOBBS NM
88240-8238
US

V. Phone/Fax

Practice location:
  • Phone: 575-393-0755
  • Fax:
Mailing address:
  • Phone: 575-393-0755
  • Fax: 575-397-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2023-0018
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: