MEDICARE: SANDRA MENDOZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1023295771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MENDOZA

Provider Business Mailing Address
First Line	:	6715 SUNSPOT CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-9258
Country	:	US
Telephone Number	:	505-496-9749
Fax Number	:

Provider Business Practice Location Address
First Line	:	6715 SUNSPOT CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-9258
Country	:	US
Telephone Number	:	505-496-9749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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Directions to “ SANDRA MENDOZA ” Practice Location

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