Provider Demographics
NPI:1972327781
Name:MENDOZA, ANNA MARIE (RDN)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3401
Mailing Address - Country:US
Mailing Address - Phone:928-821-4468
Mailing Address - Fax:
Practice Address - Street 1:58 S 12TH ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3401
Practice Address - Country:US
Practice Address - Phone:928-821-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-09
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered