Provider Demographics
NPI:1407194673
Name:MENDEZ, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MENDEZ
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 1:20476 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:TX
Mailing Address - Zip Code:78593-2084
Mailing Address - Country:US
Mailing Address - Phone:813-569-8996
Mailing Address - Fax:
Practice Address - Street 1:20476 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:TX
Practice Address - Zip Code:78593-2084
Practice Address - Country:US
Practice Address - Phone:813-569-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy