Provider Demographics
NPI:1902185317
Name:MENDEZ, GUADALUPE (RN, CCP)
Entity Type:Individual
Prefix:MRS
First Name:GUADALUPE
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:RN, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14603 HUEBNER RD
Mailing Address - Street 2:BLD 28 STE 2801
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5469
Mailing Address - Country:US
Mailing Address - Phone:210-614-7074
Mailing Address - Fax:210-614-7091
Practice Address - Street 1:14603 HUEBNER RD
Practice Address - Street 2:BLD 28 STE 2801
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5469
Practice Address - Country:US
Practice Address - Phone:210-614-7074
Practice Address - Fax:210-614-7091
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFPF00000155242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist