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NPI Code Detail

MEDICARE: MRS. SUMMER LYNN MENDOZA RD

MEDICARE:  MRS. SUMMER LYNN MENDOZA  RD
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
1133V00000XRegistered DietitianAZ

General Provider Information

NPI Number : 1619100393
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUMMER LYNN MENDOZA RD
Provider Business Mailing Address
First Line : 3406 E LINDEN ST
Second Line :
City : TUCSON
State : AZ
Zip : 85716-3240
Country : US
Telephone Number : 520-204-3590
Fax Number :
Provider Business Practice Location Address
First Line : 3406 E LINDEN ST
Second Line :
City : TUCSON
State : AZ
Zip : 85716-3240
Country : US
Telephone Number : 520-204-3590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2009
Last Update Date : 08/28/2009

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Directions to “ MRS. SUMMER LYNN MENDOZA RD” Practice Location

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