Provider Demographics
NPI:1114509445
Name:MENDOZA, LISA ELEANOR (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ELEANOR
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-1444
Mailing Address - Country:US
Mailing Address - Phone:918-599-7277
Mailing Address - Fax:
Practice Address - Street 1:101 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-1444
Practice Address - Country:US
Practice Address - Phone:719-433-9083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator