Healthcare Provider Details

I. General information

NPI: 1902609100
Provider Name (Legal Business Name): LORELI MENDOZA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 OLD HIGHWAY 99 S RD
MOUNT VERNON WA
98273-9009
US

IV. Provider business mailing address

2203 OLD HIGHWAY 99 S RD
MOUNT VERNON WA
98273-9009
US

V. Phone/Fax

Practice location:
  • Phone: 360-542-8811
  • Fax:
Mailing address:
  • Phone: 360-542-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: