Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | NM |
NPI | 1013265834 |
---|---|
Provider Name | Lidia V Mendez |
First Address | Las Cruces, NM 88005-3248 |
Second Address | Las Cruces, NM 88005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2012 |
Last Update Date | 28/08/2012 |