Provider Demographics
NPI:1144348798
Name:MENDOZA, PATRICIA (PA)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E FERN AVE
Mailing Address - Street 2:STE B-3
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1466
Mailing Address - Country:US
Mailing Address - Phone:956-971-9548
Mailing Address - Fax:956-686-0928
Practice Address - Street 1:1301 E FERN AVE
Practice Address - Street 2:STE B-3
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1466
Practice Address - Country:US
Practice Address - Phone:956-971-9548
Practice Address - Fax:956-686-0928
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04544363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX291194YLPSOtherWELLMED PTAN
TX326499601Medicaid