Provider Demographics
NPI:1467090795
Name:MENDOZA MARTINEZ, JORGE LUIS (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:MENDOZA MARTINEZ
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7749 WENDA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-2917
Mailing Address - Country:US
Mailing Address - Phone:254-317-6737
Mailing Address - Fax:
Practice Address - Street 1:7749 WENDA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-2917
Practice Address - Country:US
Practice Address - Phone:254-317-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX733842163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse