Provider Demographics
NPI:1851145122
Name:MENDOZA, DIANA (BSN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 N 124TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5201
Mailing Address - Country:US
Mailing Address - Phone:480-400-0850
Mailing Address - Fax:602-860-6050
Practice Address - Street 1:10250 N 124TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5201
Practice Address - Country:US
Practice Address - Phone:480-400-0850
Practice Address - Fax:602-860-6050
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN226853163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN226853OtherARIZONA STATE BOARD OF NURSING