Provider Demographics
NPI:1093440315
Name:MENDOZA, MARIA VERONICA DIO
Entity Type:Individual
Prefix:
First Name:MARIA VERONICA
Middle Name:DIO
Last Name: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 1:1336 S DECATUR BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-8510
Mailing Address - Country:US
Mailing Address - Phone:702-202-3844
Mailing Address - Fax:
Practice Address - Street 1:1336 S DECATUR BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8510
Practice Address - Country:US
Practice Address - Phone:702-202-3844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV845302163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management