Healthcare Provider Details

I. General information

NPI: 1871455600
Provider Name (Legal Business Name): DESIREE DAWN RUIZ MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 PAXTON RD
GALLIPOLIS OH
45631-8717
US

IV. Provider business mailing address

543 PAXTON RD
GALLIPOLIS OH
45631-8717
US

V. Phone/Fax

Practice location:
  • Phone: 828-200-3710
  • Fax:
Mailing address:
  • Phone: 828-200-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number92133
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: