1609980499 NPI number — BERNARDO MENDOZA MD

Table of content: BERNARDO MENDOZA MD (NPI 1609980499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609980499 NPI number — BERNARDO MENDOZA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDOZA
Provider First Name:
BERNARDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1609980499
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3709 N CAMPBELL AVE
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85719-1563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-320-3819
Provider Business Mailing Address Fax Number:
520-629-9430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1815 W SAINT MARYS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85745-2653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-834-4289
Provider Business Practice Location Address Fax Number:
520-628-4863
Provider Enumeration Date:
08/18/2006

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: 2086S0129X , with the licence number:  046924 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 33686 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1609980499 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00250971 . This is a "TRAVELERS MC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300051634 . This is a "ONE HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 935520 . This is a "APIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0829457 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00250971 . This is a "RR MC PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300051634 . This is a "HEALTH PLAN AHP" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 300061534 . This is a "MARICOPA FOUND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93520 . This is a "AHCCCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: DD0379 . This is a "RR MC GRP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300051634 . This is a "PACIFICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300051634 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 935520 . This is a "INDIAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 935520 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7775720 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 935520001 . This is a "MERCY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1Z9863 . This is a "INTERGROUP HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ0778710 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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