Provider Demographics
NPI:1093586935
Name:MENDOZA, ALMA D (RN)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:D
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 BIRCHGLEN ST UNIT 143
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-6512
Mailing Address - Country:US
Mailing Address - Phone:805-266-6765
Mailing Address - Fax:
Practice Address - Street 1:2264 BIRCHGLEN ST UNIT 143
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-6512
Practice Address - Country:US
Practice Address - Phone:805-266-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA734844163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse