Provider Demographics
NPI:1770241655
Name:MENDEZ, TERESA ELIZABETH IBARRA (NVLMT)
Entity Type:Individual
Prefix:
First Name:TERESA ELIZABETH
Middle Name:IBARRA
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:NVLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E GEPFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-7716
Mailing Address - Country:US
Mailing Address - Phone:775-409-9440
Mailing Address - Fax:
Practice Address - Street 1:4600 KIETZKE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5033
Practice Address - Country:US
Practice Address - Phone:702-809-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVLMT.8125225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist