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NPI Code Detail

MEDICARE: MARISOL MENDOZA

MEDICARE:   MARISOL  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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1659772317
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISOL MENDOZA
Provider Business Mailing Address
First Line : 1211 8TH ST STE C
Second Line :
City : ALAMOGORDO
State : NM
Zip : 88310-5808
Country : US
Telephone Number : 866-273-2451
Fax Number :
Provider Business Practice Location Address
First Line : 1012 MARQUEZ PLACE STE. 106B
Second Line :
City : SANTA FE
State : NM
Zip : 87505-1833
Country : US
Telephone Number : 866-273-2451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2014
Last Update Date : 10/16/2023

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Directions to “ MARISOL MENDOZA ” Practice Location

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