Provider Demographics
NPI:1629848411
Name:MENDOZA, ALLISON KATHLEEN (IBCLC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:KATHLEEN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N MARVIN AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-6302
Mailing Address - Country:US
Mailing Address - Phone:432-559-3299
Mailing Address - Fax:
Practice Address - Street 1:2301 N MARVIN AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-6302
Practice Address - Country:US
Practice Address - Phone:432-559-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-313057174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN