Basic Information
| Provider Information | |||||||||
| NPI: | 1760407159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | ESTELA | ||||||||
| MiddleName: | INCLAN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.V.N | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7808 17TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958203606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167918993 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4600 BROADWAY | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168749670 | ||||||||
| FaxNumber: | 9168749297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN136744 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.