Provider Demographics
NPI:1417306978
Name:REYES-MENDOZA, SANDRA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:REYES-MENDOZA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 HWAY 95 STE 135
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6005
Mailing Address - Country:US
Mailing Address - Phone:928-218-3493
Mailing Address - Fax:928-268-0262
Practice Address - Street 1:2135 HWY 95 STE 135
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6005
Practice Address - Country:US
Practice Address - Phone:928-218-3493
Practice Address - Fax:928-268-0262
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9605363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1417306978OtherNPI