Provider Demographics
NPI:1467719963
Name:MENDZI, MANOUELA
Entity Type:Individual
Prefix:
First Name:MANOUELA
Middle Name:
Last Name:MENDZI
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 1:8860 PINEY BRANCH RD
Mailing Address - Street 2:APT 1008
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-3547
Mailing Address - Country:US
Mailing Address - Phone:202-568-4118
Mailing Address - Fax:
Practice Address - Street 1:8860 PINEY BRANCH RD
Practice Address - Street 2:APT 1008
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3547
Practice Address - Country:US
Practice Address - Phone:202-568-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide