MEDICARE: IVANA MENDOZA LMSW, CSW-INTERN

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	104100000X	Social Worker	9712-M	NV

General Provider Information

NPI Number	:	1952088700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVANA MENDOZA LMSW, CSW-INTERN

Provider Business Mailing Address
First Line	:	3729 ROBERT MCGUIRE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5019
Country	:	US
Telephone Number	:	702-713-5543
Fax Number	:

Provider Business Practice Location Address
First Line	:	3729 ROBERT MCGUIRE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5019
Country	:	US
Telephone Number	:	702-713-5543
Fax Number	:

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

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/18/2023

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