Provider Demographics
NPI:1124257100
Name:MENDOZA, ALBERT BENJAMIN
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:BENJAMIN
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 BANDERA RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6804
Mailing Address - Country:US
Mailing Address - Phone:210-807-1976
Mailing Address - Fax:
Practice Address - Street 1:11600 BANDERA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6804
Practice Address - Country:US
Practice Address - Phone:210-807-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies