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General NPI Number Information
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NPI Number | 1780495796
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Entity Type | Individual
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Provider Name | SAMAI MENDOZA
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Gender | Female
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 8915 SW CENTER ST
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City | TIGARD
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State | OR
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Zip | 97223-6307
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Country | US
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Telephone | 503-726-3690
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Fax |
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Provider Business Mailing Address
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Address Line | 915 SE 153RD AVE APT B
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City | VANCOUVER
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State | WA
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Zip | 98683-1358
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Country | US
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Telephone | 360-521-7640
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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