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General NPI Number Information
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NPI Number | 1225768831
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Entity Type | Individual
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Provider Name | IVETTE ARIANA MENDOZA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 13737 TX-36
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City | NEEDVILLE
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State | TX
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Zip | 77461
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Country | US
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Telephone | 979-793-3940
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Fax |
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Provider Business Mailing Address
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Address Line | 5759 WANDERING CREEK DR
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City | RICHMOND
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State | TX
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Zip | 77469-6191
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Country | US
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Telephone | 832-560-1726
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1073614
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1073614
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License Number State | TX
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