Provider Demographics
NPI:1528274487
Name:MENDEZ, RICARDO (PA)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 STATE HIGHWAY 100 STE 5
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2450
Mailing Address - Country:US
Mailing Address - Phone:956-943-6675
Mailing Address - Fax:956-943-6864
Practice Address - Street 1:1200 STATE HIGHWAY 100 STE 5
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2450
Practice Address - Country:US
Practice Address - Phone:956-943-6675
Practice Address - Fax:956-943-6864
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00767024OtherRAILROAD MEDICARE
TX8L20023Medicare PIN