Healthcare Provider Details

I. General information

NPI: 1871418327
Provider Name (Legal Business Name): LIZBET MADRIGAL-MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 ISAACS AVE APT H303
WALLA WALLA WA
99362-2281
US

IV. Provider business mailing address

2222 ISAACS AVE APT H303
WALLA WALLA WA
99362-2281
US

V. Phone/Fax

Practice location:
  • Phone: 541-561-4167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMAC.CM.61032812
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: