Provider Demographics
NPI:1295453835
Name:MENDOZA, MILAGROS MICAELA
Entity type:Individual
Prefix:
First Name:MILAGROS MICAELA
Middle Name:
Last Name:MENDOZA
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 1:2810 W CHARLESTON BLVD STE E-48
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1921
Mailing Address - Country:US
Mailing Address - Phone:702-878-5504
Mailing Address - Fax:
Practice Address - Street 1:2210 SAWTOOTH MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-0108
Practice Address - Country:US
Practice Address - Phone:725-777-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV823055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily