Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 13K0000X | NV |
N | 103TR0400X | Rehabilitation Psychologist | 103TRX040X | NV |
NPI | 1316293574 |
---|---|
Provider Name | Carlos Alberto Mendoza |
First Address | Reno, NV 89502-7916 |
Second Address | Reno, NV 89502-7916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2012 |
Last Update Date | 25/07/2012 |