MEDICARE: LOUISA MENDEZ

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	385H00000X	Respite Care
2	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1255590428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISA MENDEZ

Provider Business Mailing Address
First Line	:	167 KOEPSEL RD
Second Line	:
City	:	MC QUEENEY
State	:	TX
Zip	:	78123-3535
Country	:	US
Telephone Number	:	830-556-4945
Fax Number	:

Provider Business Practice Location Address
First Line	:	167 KOEPSEL RD
Second Line	:
City	:	MC QUEENEY
State	:	TX
Zip	:	78123-3535
Country	:	US
Telephone Number	:	830-556-0063
Fax Number	:

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	01/14/2020

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Directions to “ LOUISA MENDEZ ” Practice Location

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