1902284110 NPI number — DR. HUMBERTO GERARDO MENDOZA M.D.

Table of content: DR. HUMBERTO GERARDO MENDOZA M.D. (NPI 1902284110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902284110 NPI number — DR. HUMBERTO GERARDO MENDOZA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDOZA
Provider First Name:
HUMBERTO
Provider Middle Name:
GERARDO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1902284110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
267 GRANT STREET
Provider Second Line Business Mailing Address:
MED ED PODIUM 4
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06610-0120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
267 GRANT STREET
Provider Second Line Business Practice Location Address:
MED ED PODIUM 4
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06610-0120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-384-4442
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2015

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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