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General NPI Number Information
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NPI Number | 1659763324
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Entity Type | Individual
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Provider Name | KATIE MENDOZA BA
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Gender | Female
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 1720 N 62ND ST
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City | LINCOLN
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State | NE
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Zip | 68505-1202
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Country | US
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Telephone | 951-347-4039
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Fax |
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Provider Business Mailing Address
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Address Line | 4246 MILL CREEK ST
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City | RIVERSIDE
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State | CA
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Zip | 92509
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Country | US
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Telephone |
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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