Provider Demographics
NPI:1316106982
Name:MENDOZA, ROSA ISELA (RN)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:ISELA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 FM 2604
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-4664
Mailing Address - Country:US
Mailing Address - Phone:254-694-7144
Mailing Address - Fax:
Practice Address - Street 1:1409 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-7624
Practice Address - Country:US
Practice Address - Phone:254-694-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695861163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice