Provider Demographics
NPI:1164203279
Name:MENDOZA, MIRANDA LIZETTE (LPA)
Entity Type:Individual
Prefix:MISS
First Name:MIRANDA
Middle Name:LIZETTE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 S 30 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-8036
Mailing Address - Country:US
Mailing Address - Phone:956-890-5999
Mailing Address - Fax:
Practice Address - Street 1:423 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2915
Practice Address - Country:US
Practice Address - Phone:956-600-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40004103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist