MEDICARE: CAMILLE ASHLEY 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	163WM0705X	Medical-Surgical Registered Nurse	RN70047881	WA

General Provider Information

NPI Number	:	1194683110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE ASHLEY MENDOZA

Provider Business Mailing Address
First Line	:	1660 S COLUMBIAN WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 S COLUMBIAN WAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98108-1532
Country	:	US
Telephone Number	:	206-762-1010
Fax Number	:

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

Provider Enumeration Date	:	01/10/2026
Last Update Date	:	01/10/2026

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Directions to “ CAMILLE ASHLEY MENDOZA ” Practice Location

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