Provider Demographics
NPI:1699290858
Name:MENDOZA, RACHELLE PACAANAS (MD)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:PACAANAS
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVENUE
Mailing Address - Street 2:BOX 626
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5662
Mailing Address - Fax:585-276-2390
Practice Address - Street 1:5841 S MARYLAND AVE RM S626
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1443
Practice Address - Country:US
Practice Address - Phone:718-270-8173
Practice Address - Fax:718-270-3313
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036155003207ZP0102X
IL036.155003207ZP0102X
NY315420207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology