Provider Demographics
NPI:1447040688
Name:MENDIOLA, BARON LEARY
Entity type:Individual
Prefix:
First Name:BARON
Middle Name:LEARY
Last Name:MENDIOLA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 WATANABE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6682
Mailing Address - Country:US
Mailing Address - Phone:702-806-1456
Mailing Address - Fax:
Practice Address - Street 1:6121 WATANABE ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6682
Practice Address - Country:US
Practice Address - Phone:702-806-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care