MEDICARE: MARIE CLAIRE 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	163W00000X	Registered Nurse	1168331	TX

General Provider Information

NPI Number	:	1487532032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE CLAIRE MENDOZA

Provider Business Mailing Address
First Line	:	3739 S HIGHWAY 161 APT 3301
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-9022
Country	:	US
Telephone Number	:	682-395-6034
Fax Number	:

Provider Business Practice Location Address
First Line	:	10840 TEXAS HEALTH TRL STE 270
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6849
Country	:	US
Telephone Number	:	817-670-2374
Fax Number	:

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

Provider Enumeration Date	:	08/22/2025
Last Update Date	:	08/22/2025

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Directions to “ MARIE CLAIRE MENDOZA ” Practice Location

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