Provider Demographics
NPI:1396089009
Name:MENDIETA, MAGDA R (RN, IBCLC RLC)
Entity type:Individual
Prefix:
First Name:MAGDA
Middle Name:R
Last Name:MENDIETA
Suffix:
Gender:F
Credentials:RN, IBCLC RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 LORETO DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6326
Mailing Address - Country:US
Mailing Address - Phone:956-740-9975
Mailing Address - Fax:
Practice Address - Street 1:1906 LORETO DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6326
Practice Address - Country:US
Practice Address - Phone:956-740-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11258766163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant