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NPI Code Detail

MEDICARE: MRS. MAYRA MENDOZA

MEDICARE: MRS. MAYRA 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
1163WP0200XPediatric Registered Nurse684875CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1EPS015750OTHERCAPROVIDER NUMBER

General Provider Information

NPI Number : 1528277985
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MAYRA MENDOZA
Provider Business Mailing Address
First Line : 6313 W. BROWNING AVE.
Second Line :
City : FRESNO
State : CA
Zip : 93723-7663
Country : US
Telephone Number : 559-277-9379
Fax Number :
Provider Business Practice Location Address
First Line : 6313 W. BROWNING AVE.
Second Line :
City : FRESNO
State : CA
Zip : 93723-7663
Country : US
Telephone Number : 559-277-9379
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 07/08/2007

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