Individual
MS. JAQUELINE MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11334 SSG SIMS, FT. BLISS, TX 79908
(915) 301-4590
Mailing address
336 RALPH ST, CHAPARRAL, NM 88081-7559
(915) 301-4590
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
35054
TX
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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