Provider Demographics
NPI:1265910772
Name:MENDEZ, YAJAIRA LIZBETH
Entity type:Individual
Prefix:
First Name:YAJAIRA
Middle Name:LIZBETH
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 COWBOYS COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-6077
Mailing Address - Country:US
Mailing Address - Phone:214-762-6689
Mailing Address - Fax:
Practice Address - Street 1:3911 COWBOYS COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-6077
Practice Address - Country:US
Practice Address - Phone:214-762-6689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA1274225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant