Healthcare Provider Details

I. General information

NPI: 1982326294
Provider Name (Legal Business Name): NORMA ARACELY MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 CAMINO CAPILLA VIEJA
SANTA FE NM
87507-4270
US

IV. Provider business mailing address

78 CAMINO CAPILLA VIEJA
SANTA FE NM
87507-4270
US

V. Phone/Fax

Practice location:
  • Phone: 505-490-5832
  • Fax:
Mailing address:
  • Phone: 505-490-5832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: