Provider Demographics
NPI:1578221420
Name:MENDOZA, GEORGINA
Entity Type:Individual
Prefix:MRS
First Name:GEORGINA
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 1:261 RODEO TRL
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-0302
Mailing Address - Country:US
Mailing Address - Phone:830-734-7496
Mailing Address - Fax:
Practice Address - Street 1:315 GRINER STREET
Practice Address - Street 2:PO DRAWER 428002
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840
Practice Address - Country:US
Practice Address - Phone:830-778-4714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist