Provider Demographics
NPI:1306941869
Name:MENDONCA, BRANDI ACACIA (MD)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:ACACIA
Last Name:MENDONCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9108
Mailing Address - Country:US
Mailing Address - Phone:503-472-4197
Mailing Address - Fax:503-434-2886
Practice Address - Street 1:2163 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9108
Practice Address - Country:US
Practice Address - Phone:503-472-4197
Practice Address - Fax:503-434-2886
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine