Individual
MRS. MAYRA MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6313 W. BROWNING AVE., FRESNO, CA 93723-7663
(559) 277-9379
Mailing address
6313 W. BROWNING AVE., FRESNO, CA 93723-7663
(559) 277-9379
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
684875
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EPS015750
PROVIDER NUMBER
CA
Enumeration date
05/22/2007
Last updated
07/08/2007
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