Provider Demographics
NPI:1154704039
Name:MENDOZA, LAURA (LVN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S 1ST AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3936
Mailing Address - Country:US
Mailing Address - Phone:559-318-8464
Mailing Address - Fax:
Practice Address - Street 1:320 S 1ST AVE APT 101
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3936
Practice Address - Country:US
Practice Address - Phone:559-318-8464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201776164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse