Healthcare Provider Details

I. General information

NPI: 1366000804
Provider Name (Legal Business Name): MS. MERLINDA MARIE MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 E FLAMINGO RD STE 220A
LAS VEGAS NV
89119-0850
US

IV. Provider business mailing address

8440 WESTCLIFF DR APT 2056
LAS VEGAS NV
89145-3914
US

V. Phone/Fax

Practice location:
  • Phone: 702-712-5964
  • Fax:
Mailing address:
  • Phone: 702-759-2946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: