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General NPI Number Information
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NPI Number | 1669063798
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Entity Type | Organization
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Legal Business Name | BREEZY MENDOZA NP LLC
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Dates
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Enumeration Date | 02/01/2021
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 5555 W THUNDERBIRD RD
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City | GLENDALE
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State | AZ
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Zip | 85306-4622
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Country | US
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Telephone | 480-257-6383
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Fax |
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Provider Business Mailing Address
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Address Line | 10031 W VIA MONTOYA DR
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City | PEORIA
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State | AZ
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Zip | 85383-3299
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Country | US
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Telephone | 480-257-6383
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BREEZY MENDOZA
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Credential | NP
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Telephone | 480-257-6383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number |
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License Number State |
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