Provider Demographics
NPI:1417005273
Name:TIENDA, MAYRA LUZ
Entity Type:Individual
Prefix:MS
First Name:MAYRA
Middle Name:LUZ
Last Name:TIENDA
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 1:10378 E ANNADALE AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-9725
Mailing Address - Country:US
Mailing Address - Phone:559-876-2323
Mailing Address - Fax:
Practice Address - Street 1:205 N BLACKSTONE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1914
Practice Address - Country:US
Practice Address - Phone:559-498-0241
Practice Address - Fax:559-498-6220
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner