Provider Demographics
NPI:1053012484
Name:MENDEZ, LATOYA AUDIE (LPN)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:AUDIE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 WASHINGTON AVE APT A4
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-3841
Mailing Address - Country:US
Mailing Address - Phone:862-704-3222
Mailing Address - Fax:
Practice Address - Street 1:265 WASHINGTON AVE APT A4
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-3841
Practice Address - Country:US
Practice Address - Phone:862-704-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337935-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty