Provider Demographics
NPI:1013325737
Name:MENDOZA, CHRISTA QUILANETA (MAS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:QUILANETA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 TOWNEHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2867
Mailing Address - Country:US
Mailing Address - Phone:631-846-9213
Mailing Address - Fax:
Practice Address - Street 1:2505 TOWNEHOUSE DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2867
Practice Address - Country:US
Practice Address - Phone:631-846-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program