Provider Demographics
NPI:1992889778
Name:MENDEZ, CRESENT JR
Entity type:Individual
Prefix:MR
First Name:CRESENT
Middle Name:
Last Name:MENDEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CRESENT
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PA-C, MPAS
Mailing Address - Street 1:1405 BUTTERFLY LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-2195
Mailing Address - Country:US
Mailing Address - Phone:469-231-6286
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-1748
Practice Address - Fax:214-857-1719
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical