Provider Demographics
NPI:1528352200
Name:MENDOZA, NATALIA (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:ZUNI COMPREHENSIVE COMMUNITY HEALTH CENTER MED STAFF
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-0467
Mailing Address - Country:US
Mailing Address - Phone:505-782-4431
Mailing Address - Fax:505-782-7405
Practice Address - Street 1:ROUTE 301 NORTH B AVENUE
Practice Address - Street 2:ZUNI COMPREHENSIVE COMMUNITY HEALTH CENTER
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327
Practice Address - Country:US
Practice Address - Phone:505-782-4431
Practice Address - Fax:505-782-7405
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2015-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA60393010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03671267Medicaid
NM03671267Medicaid