OLIVIA MENDOZA (NPI# 1104452010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104452010 |
| Entity Type | Individual |
| Full Name | OLIVIA MENDOZA |
| Credential | NP |
| Practice Address |
269 Medical Park Blvd Petersburg VA 23805-9337 |
| Mailing Address |
207 N 4th Ave Hopewell VA 23860-2503 |
| Practice Telephone | 8048610700 |
| Mailing Telephone | 8045410918 |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2020-03-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
0024179022 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619331410 | Olivia Mendoza | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2917 Frutas Ave, El Paso, TX 79905-1007 | 2016-04-07 |
| 1760832620 | Olivia Mendoza | Social Worker | 9315 Telegraph Rd, Redford, MI 48239-1260 | 2016-06-21 |
| Street Address |
269 MEDICAL PARK BLVD |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9337 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700857836 | Haluk K Aydin | Psychiatry & Neurology | 269 Medical Park Blvd, Petersburg, VA 23805-9337 | 2006-01-27 |
| 1700234622 | Sunny Hong | Psychologist | 269 Medical Park Blvd, Petersburg, VA 23805-9337 | 2016-06-01 |
| 1114121829 | Devi Vasu | Psychiatry & Neurology | 269 Medical Park Blvd, Petersburg, VA 23805-9337 | 2007-06-14 |
| 1700894466 | Virginia South Psychiatric & Family Services | Psychiatry & Neurology | 269 Medical Park Blvd, Petersburg, VA 23805 | 2006-08-04 |
| 1851330443 | Ramesh C. Agarwal | Psychiatry & Neurology | 269 Medical Park Blvd, Petersburg, VA 23805-9337 | 2006-06-06 |
| 1609831544 | Ramesh B. Koduri | Psychiatry & Neurology | 269 Medical Park Blvd, Petersburg, VA 23805-9337 | 2006-04-20 |
| 1003871989 | Thresa Helen Simon | Psychiatry & Neurology | 269 Medical Park Blvd, Petersburg, VA 23805-9337 | 2006-04-20 |
| 1942265509 | C. Rao Amara | Psychiatry & Neurology | 269 Medical Park Blvd, Petersburg, VA 23805-9337 | 2006-04-18 |
| 1699734517 | James W Wooldridge Jr. | Psychiatry & Neurology | 269 Medical Park Blvd, Petersburg, VA 23805-9337 | 2006-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578160875 | Tricia Daigle Northington | Nurse Practitioner | 20213 Eagle Cove Ct, South Chesterfield, VA 23803-1097 | 2020-10-08 |
| 1114524543 | Alliance Mental Health LLC | Nurse Practitioner | 7400 Beaufont Springs Drive Pmb#2867, Suite 300, Richmond, VA 23225 | 2020-10-08 |
| 1699372060 | Shari Chism Medley | Nurse Practitioner | 1088 Bagwell Dr, Scottsburg, VA 24589-2709 | 2020-10-07 |
| 1225635683 | Kevina Boone | Nurse Practitioner | 5360 Discovery Park Blvd Ste 201, Williamsburg, VA 23188-2860 | 2020-10-07 |
| 1548876618 | Jamie Kim | Nurse Practitioner | 3554 Chain Bridge Rd Ste 200, Fairfax, VA 22030-2709 | 2020-09-23 |
| 1134734957 | Ai H Garner | Nurse Practitioner | 7400 Beaufont Springs Drive Pmb# 2867, Suite 300, Richmond, VA 23225 | 2020-09-09 |
| 1679185573 | Shaping Your Future Psychiatry | Nurse Practitioner | 1534 Bateau Lndg, Chesapeake, VA 23321-6603 | 2020-08-20 |
| 1235749714 | Germaine Kelley-pope | Nurse Practitioner | 622 Westover Hills Blvd, Richmond, VA 23225-4521 | 2020-08-09 |
| 1164031779 | Georgina Rose Chidaushe | Nurse Practitioner | 46760 Vermont Maple Ter, Sterling, VA 20164-2234 | 2020-07-29 |
| 1689292575 | Harpreet Kang | Nurse Practitioner | 2925 Calcutt Dr, Midlothian, VA 23113-2682 | 2020-07-08 |
| Find all providers with the same taxonomy | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.