Individual
BLANCA MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2708 MAZON AVE, GALLUP, NM 87301-4671
(505) 870-0479
Mailing address
2708 MAZON AVE, GALLUP, NM 87301-4671
(505) 870-0479
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
12/18/2017
Last updated
12/18/2017
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