1144348798 NPI number — MS. PATRICIA MENDOZA PA

Table of content: MS. PATRICIA MENDOZA PA (NPI 1144348798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144348798 NPI number — MS. PATRICIA MENDOZA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDOZA
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1144348798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 E FERN AVE
Provider Second Line Business Mailing Address:
STE B-3
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78501-1466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-971-9548
Provider Business Mailing Address Fax Number:
956-686-0928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 E FERN AVE
Provider Second Line Business Practice Location Address:
STE B-3
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78501-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-971-9548
Provider Business Practice Location Address Fax Number:
956-686-0928
Provider Enumeration Date:
03/26/2007

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: 363A00000X , with the licence number:  PA04544 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 291194YLPS . This is a "WELLMED PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 326499601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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