Provider Demographics
NPI:1871455600
Name:RUIZ MENDOZA, DESIREE DAWN
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:DAWN
Last Name:RUIZ MENDOZA
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 1:543 PAXTON RD
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-8717
Mailing Address - Country:US
Mailing Address - Phone:828-200-3710
Mailing Address - Fax:
Practice Address - Street 1:543 PAXTON RD
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-8717
Practice Address - Country:US
Practice Address - Phone:828-200-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV92133374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide