Provider Demographics
NPI:1114797479
Name:MENDOZA, MARISABEL ANNE
Entity Type:Individual
Prefix:
First Name:MARISABEL
Middle Name:ANNE
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 1:207 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-6108
Mailing Address - Country:US
Mailing Address - Phone:707-331-7402
Mailing Address - Fax:
Practice Address - Street 1:2235 MERCURY WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5473
Practice Address - Country:US
Practice Address - Phone:707-571-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist