Healthcare Provider Details

I. General information

NPI: 1609692573
Provider Name (Legal Business Name): AMBER MENDOZA BSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14837 TED BANKS AVE
EL PASO TX
79938-3143
US

IV. Provider business mailing address

14837 TED BANKS AVE
EL PASO TX
79938-3143
US

V. Phone/Fax

Practice location:
  • Phone: 915-238-9833
  • Fax:
Mailing address:
  • Phone: 915-238-9833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number1141798
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: