MEDICARE: JENICA C MENDIETA SPLA

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	2355S0801X	Speech-Language Assistant		TX

General Provider Information

NPI Number	:	1831959824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENICA C MENDIETA SPLA

Provider Business Mailing Address
First Line	:	13202 BRIAR FOREST DR UNIT 13202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-2434
Country	:	US
Telephone Number	:	786-291-5170
Fax Number	:

Provider Business Practice Location Address
First Line	:	13202 BRIAR FOREST DR UNIT 13202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-2434
Country	:	US
Telephone Number	:	786-291-5170
Fax Number	:

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

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	03/19/2024

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Directions to “ JENICA C MENDIETA SPLA” Practice Location

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