Basic Information
| Provider Information | |||||||||
| NPI: | 1124176409 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | HERLINDA | ||||||||
| MiddleName: | EVA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LVN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 47825 OASIS ST | ||||||||
| Address2: | |||||||||
| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922016950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608638455 | ||||||||
| FaxNumber: | 7608563858 | ||||||||
| Practice Location | |||||||||
| Address1: | 47825 OASIS ST | ||||||||
| Address2: | |||||||||
| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922016950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608638455 | ||||||||
| FaxNumber: | 7608563857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 12/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 164X00000X | VN71701 | CA | N | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.