=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811541881
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LIBRADA MENDOZA COX
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2019
-----------------------------------------------------
Last Update Date | 07/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2211 GARDEN HWY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95833-9741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-743-1424
-----------------------------------------------------
Fax | 916-922-3725
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2211 GARDEN HWY
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95833-9741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-743-1424
-----------------------------------------------------
Fax | 916-922-3725
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | FBNF2019-05954
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------