Provider Demographics
NPI:1336472844
Name:MENDOZA, JOSEFINA RAMIREZ (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:RAMIREZ
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937-0370
Mailing Address - Country:US
Mailing Address - Phone:575-267-3280
Mailing Address - Fax:575-267-1747
Practice Address - Street 1:125 CHAPARREL BLVD NW
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-8629
Practice Address - Country:US
Practice Address - Phone:575-546-4800
Practice Address - Fax:575-546-0685
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-01227311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical