1063203347 NPI number — PEACE LOVE WELLNESS HEALTH SYSTEM

Table of content: JOSE ROBERTO MENDOZA M.D. (NPI 1851349518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063203347 NPI number — PEACE LOVE WELLNESS HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEACE LOVE WELLNESS HEALTH SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063203347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
636 GAUSE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70458-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-260-1999
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
636 GAUSE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70458-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-260-1999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2025

Additional Information

Authorized Official

Authorized Official Last Name:
RILEY
Authorized Official First Name:
LAKENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
NATUROPATHIC PRACTITIONER
Authorized Official Telephone Number:
985-260-1999

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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