Provider Demographics
NPI:1790045342
Name:CARRANZA, NOE MENDES (DC)
Entity Type:Individual
Prefix:
First Name:NOE
Middle Name:MENDES
Last Name:CARRANZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N 91ST AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4051
Mailing Address - Country:US
Mailing Address - Phone:623-252-1512
Mailing Address - Fax:
Practice Address - Street 1:4494 W PEORIA AVE
Practice Address - Street 2:SUITE #116
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-2023
Practice Address - Country:US
Practice Address - Phone:623-252-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor