Provider Demographics
NPI:1336286475
Name:MENDOZA, ISABEL (MD)
Entity type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ISABEL
Other - Middle Name:
Other - Last Name:MENDOZA-OLIVERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8906 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6366
Mailing Address - Country:US
Mailing Address - Phone:803-254-3676
Mailing Address - Fax:803-254-3678
Practice Address - Street 1:201 CASHUA ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3301
Practice Address - Country:US
Practice Address - Phone:843-393-7452
Practice Address - Fax:843-393-6210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39007207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC390071Medicaid