Healthcare Provider Details

I. General information

NPI: 1013416668
Provider Name (Legal Business Name): DOLORES DE LA CARIDAD MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 STELLA LAKE ST STE 36
LAS VEGAS NV
89106-2144
US

IV. Provider business mailing address

5576 W ROCHELLE AVE APT 38D
LAS VEGAS NV
89103-3420
US

V. Phone/Fax

Practice location:
  • Phone: 702-888-1415
  • Fax:
Mailing address:
  • Phone: 702-300-6866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number1605183840
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: