Provider Demographics
NPI:1487532032
Name:MENDOZA, MARIE CLAIRE
Entity type:Individual
Prefix:
First Name:MARIE CLAIRE
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 S HIGHWAY 161 APT 3301
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-9022
Mailing Address - Country:US
Mailing Address - Phone:682-395-6034
Mailing Address - Fax:
Practice Address - Street 1:10840 TEXAS HEALTH TRL STE 270
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6849
Practice Address - Country:US
Practice Address - Phone:817-670-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168331163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse