Provider Demographics
NPI:1609664812
Name:MENDOZA, IKE H (APRN)
Entity type:Individual
Prefix:
First Name:IKE
Middle Name:H
Last Name:MENDOZA
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 SAWTOOTH MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-0108
Mailing Address - Country:US
Mailing Address - Phone:725-777-6566
Mailing Address - Fax:
Practice Address - Street 1:5660 W FLAMINGO RD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2312
Practice Address - Country:US
Practice Address - Phone:702-890-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV837860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily