1609825132 NPI number — DR. PEDRO G MENDOZA M.D. FCCP

Table of content: DR. PEDRO G MENDOZA M.D. FCCP (NPI 1609825132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609825132 NPI number — DR. PEDRO G MENDOZA M.D. FCCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDOZA
Provider First Name:
PEDRO
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D. FCCP
Provider Gender Code:
M

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:
1609825132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W CENTURY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISMARCK
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58503-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-323-9900
Provider Business Mailing Address Fax Number:
701-323-9911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W CENTURY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58503-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-323-9900
Provider Business Practice Location Address Fax Number:
701-323-9911
Provider Enumeration Date:
05/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  5553 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15689 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: N712611 . This is a "MEDICARE SOLO #" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 12293 . This is a "MEDICIAD GROUP NUMBER" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 22774 . This is a "BCBS OF ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".