MEDICARE: ISSAC MICHAEL 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	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497181234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISSAC MICHAEL MENDOZA

Provider Business Mailing Address
First Line	:	1320 DAWLEY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5512
Country	:	US
Telephone Number	:	702-689-2471
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 DAWLEY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-5512
Country	:	US
Telephone Number	:	702-689-2471
Fax Number	:

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

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	09/25/2013

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