Provider Demographics
NPI:1265109912
Name:MENDOZA VEGA, LISBETH
Entity type:Individual
Prefix:
First Name:LISBETH
Middle Name:
Last Name:MENDOZA VEGA
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 1:2950 E FLAMINGO RD STE H
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5208
Mailing Address - Country:US
Mailing Address - Phone:725-251-3854
Mailing Address - Fax:725-780-1114
Practice Address - Street 1:417 FOXVALE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-6150
Practice Address - Country:US
Practice Address - Phone:702-619-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
NV873940163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant