Provider Demographics
NPI:1679205595
Name:MENDOZA, TULA MARIA (PHN)
Entity Type:Individual
Prefix:
First Name:TULA
Middle Name:MARIA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 E DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-4503
Mailing Address - Country:US
Mailing Address - Phone:408-910-6262
Mailing Address - Fax:
Practice Address - Street 1:1604 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-4926
Practice Address - Country:US
Practice Address - Phone:559-675-7893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95163872163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health