Provider Demographics
NPI:1396036059
Name:MENDOZA, JAYLEEN K (RN)
Entity Type:Individual
Prefix:
First Name:JAYLEEN
Middle Name:K
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-1332 PUNAWAINUI ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2823
Mailing Address - Country:US
Mailing Address - Phone:928-287-6657
Mailing Address - Fax:
Practice Address - Street 1:287 KAMOKILA BLVD
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2081
Practice Address - Country:US
Practice Address - Phone:808-954-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA791667163W00000X
HIRN-75760163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse