Provider Demographics
NPI:1386710523
Name:MENDOZA MEDICAL LLC
Entity type:Organization
Organization Name:MENDOZA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:520-297-3907
Mailing Address - Street 1:PO BOX 36627
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-6627
Mailing Address - Country:US
Mailing Address - Phone:520-297-3907
Mailing Address - Fax:520-989-3486
Practice Address - Street 1:2001 W ORANGE GROVE RD
Practice Address - Street 2:SUITE 312
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1139
Practice Address - Country:US
Practice Address - Phone:520-297-3907
Practice Address - Fax:520-989-3486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35869261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ111992Medicare PIN