Provider Demographics
NPI:1588351183
Name:MENDONCA, ROSA LITA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:LITA
Last Name:MENDONCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10002 COURTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-6678
Mailing Address - Country:US
Mailing Address - Phone:804-717-5881
Mailing Address - Fax:
Practice Address - Street 1:10002 COURTVIEW LN
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6678
Practice Address - Country:US
Practice Address - Phone:804-717-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor