Provider Demographics
NPI:1447388038
Name:MENDOZA, DELIA
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:MENDOZA
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 1:9 E CHALLENGER ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-8461
Mailing Address - Country:US
Mailing Address - Phone:505-347-2409
Mailing Address - Fax:505-347-2537
Practice Address - Street 1:9 E CHALLENGER ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-8461
Practice Address - Country:US
Practice Address - Phone:505-347-2409
Practice Address - Fax:505-347-2537
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-04972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health