Provider Demographics
NPI:1841647138
Name:MENDIOLA, KAREN JANE
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JANE
Last Name:MENDIOLA
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 1:23110 DRAGON ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ELMENDORF
Mailing Address - State:TX
Mailing Address - Zip Code:78112-6128
Mailing Address - Country:US
Mailing Address - Phone:210-440-6769
Mailing Address - Fax:
Practice Address - Street 1:23110 DRAGON ROCK RD
Practice Address - Street 2:
Practice Address - City:ELMENDORF
Practice Address - State:TX
Practice Address - Zip Code:78112-6128
Practice Address - Country:US
Practice Address - Phone:210-440-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93533164X00000X
TX68930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No164X00000XNursing Service ProvidersLicensed Vocational Nurse