Provider Demographics
NPI:1265233852
Name:MENDONCA, YVETTE (CCSS)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:MENDONCA
Suffix:
Gender:
Credentials:CCSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N RIVERSIDE DR STE 6
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2916
Mailing Address - Country:US
Mailing Address - Phone:505-367-3500
Mailing Address - Fax:505-367-3503
Practice Address - Street 1:908 N RIVERSIDE DR STE 6
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2916
Practice Address - Country:US
Practice Address - Phone:505-367-3500
Practice Address - Fax:505-367-3503
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker