Provider Demographics
NPI:1144969973
Name:MENDOZA-BALLENTINE, STEPHANIE REBECCA (ND)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:REBECCA
Last Name:MENDOZA-BALLENTINE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:5924 TALLEY CT
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6670
Mailing Address - Country:US
Mailing Address - Phone:702-927-9641
Mailing Address - Fax:
Practice Address - Street 1:20414 N 51ST DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-9314
Practice Address - Country:US
Practice Address - Phone:151-263-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21-1675175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath