Provider Demographics
NPI:1821235375
Name:MENDOZA, YVETTE MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:MARIE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:MARIE
Other - Last Name:GOULARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4150 V. STREET, PSSB SUITE 1200
Mailing Address - Street 2:UCDMC DEPT. OF ANESTHESIOLOGY & PAIN MEDICINE
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:559-313-5214
Mailing Address - Fax:916-734-2975
Practice Address - Street 1:4150 V STREET, PSSB SUITE 1200
Practice Address - Street 2:UCDMC DEPT. OF ANESTHESIOLOGY & PAIN MEDICINE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-5042
Practice Address - Fax:916-734-2975
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623186 RN367500000X
CA3776367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA623186OtherRN LICENSE