Healthcare Provider Details

I. General information

NPI: 1881437606
Provider Name (Legal Business Name): CELIA A MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8810 AVENUE J
BROOKLYN NY
11236-3919
US

IV. Provider business mailing address

7222 66TH DR
MIDDLE VILLAGE NY
11379-2112
US

V. Phone/Fax

Practice location:
  • Phone: 718-866-4569
  • Fax:
Mailing address:
  • Phone: 347-987-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: