Provider Demographics
NPI:1558935544
Name:MENDOZA, LAURA VENCES (CRM, NCMA, TSH, PSS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:VENCES
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CRM, NCMA, TSH, PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10209 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1372
Mailing Address - Country:US
Mailing Address - Phone:503-719-7609
Mailing Address - Fax:
Practice Address - Street 1:971 SW WALNUT ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-5651
Practice Address - Country:US
Practice Address - Phone:503-640-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program