MEDICARE: MARILOU ABELLANA MENDOZA NP

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	363LP2300X	Primary Care Nurse Practitioner	001480	NV
2	363LP2300X	Primary Care Nurse Practitioner	809970	CA
3	363LP2300X	Primary Care Nurse Practitioner	95009540	CA

General Provider Information

NPI Number	:	1528307659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILOU ABELLANA MENDOZA NP

Provider Business Mailing Address
First Line	:	7829 MISSION POINT LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-5143
Country	:	US
Telephone Number	:	702-300-4421
Fax Number	:

Provider Business Practice Location Address
First Line	:	7829 MISSION POINT LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-5143
Country	:	US
Telephone Number	:	702-300-4421
Fax Number	:

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

Provider Enumeration Date	:	02/08/2013
Last Update Date	:	06/22/2021

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