Provider Demographics
NPI:1578725586
Name:MENDOZA, ELLENA T (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ELLENA
Middle Name:T
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 VALLEY VIEW DR
Mailing Address - Street 2:STE 305
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-3130
Mailing Address - Country:US
Mailing Address - Phone:970-874-7178
Mailing Address - Fax:970-874-7178
Practice Address - Street 1:1410 VALLEY VIEW DR
Practice Address - Street 2:STE 305
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-3130
Practice Address - Country:US
Practice Address - Phone:970-874-7178
Practice Address - Fax:970-874-7178
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO608174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist