Provider Demographics
NPI:1225897143
Name:MENDOZA, YAHEIDY (LE, CPE)
Entity Type:Individual
Prefix:
First Name:YAHEIDY
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LE, CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1738
Mailing Address - Country:US
Mailing Address - Phone:708-407-9294
Mailing Address - Fax:
Practice Address - Street 1:2722 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1738
Practice Address - Country:US
Practice Address - Phone:708-407-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL220000234156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist