Provider Demographics
NPI:1689099814
Name:MENDEZ, CANDIDA
Entity Type:Individual
Prefix:
First Name:CANDIDA
Middle Name:
Last Name:MENDEZ
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 1:3517 181ST ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98446-2711
Mailing Address - Country:US
Mailing Address - Phone:818-468-2879
Mailing Address - Fax:
Practice Address - Street 1:3705 S MERIDIAN STE B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3709
Practice Address - Country:US
Practice Address - Phone:253-765-5050
Practice Address - Fax:844-695-2929
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA673573163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse