Provider Demographics
NPI:1750972675
Name:MENDOZA, MELISSA YVETTE (RDN, LDN)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:YVETTE
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2719
Mailing Address - Country:US
Mailing Address - Phone:224-201-6342
Mailing Address - Fax:
Practice Address - Street 1:431 S LAKE ST
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2719
Practice Address - Country:US
Practice Address - Phone:224-201-6342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164-00-7601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty