Basic Information
| Provider Information | |||||||||
| NPI: | 1922432533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | NATALIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10165 STONEHENGE CIR | ||||||||
| Address2: | APT 1519 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334373581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545475565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2753 VISTA PKWY | ||||||||
| Address2: | 110A | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334116752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616835758 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2013 | ||||||||
| LastUpdateDate: | 08/30/2013 | ||||||||
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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 | 302F00000X | FL | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.