Provider Demographics
NPI:1649882929
Name:MENDOZA EALY, NAOMI (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:MENDOZA EALY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 W BARTLETT WAY
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VLY
Mailing Address - State:AZ
Mailing Address - Zip Code:85144-6614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1846 E INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1963
Practice Address - Country:US
Practice Address - Phone:520-771-0555
Practice Address - Fax:262-260-9109
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ144243163W00000X
WI16338-33363LP0808X
AZ2023032962363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse