Individual
TANIA MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5298
(541) 766-6835
Mailing address
2406 NW JACKSON AVE APT 3, CORVALLIS, OR 97330-5389
(541) 571-8736
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IHN
INTERCOMMUNITY HEALTH PLAN
OR
Enumeration date
10/16/2021
Last updated
10/16/2021
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