Healthcare Provider Details

I. General information

NPI: 1841647138
Provider Name (Legal Business Name): DR. KAREN JANE MENDIOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23110 DRAGON ROCK RD
ELMENDORF TX
78112-6128
US

IV. Provider business mailing address

23110 DRAGON ROCK RD
ELMENDORF TX
78112-6128
US

V. Phone/Fax

Practice location:
  • Phone: 210-440-6769
  • Fax:
Mailing address:
  • Phone: 210-440-6769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number93533
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number68930
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: