Provider Demographics
NPI:1548696214
Name:JOSEPH MENDOZZA, MD PC
Entity type:Organization
Organization Name:JOSEPH MENDOZZA, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:MENDOZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-758-2500
Mailing Address - Street 1:4770 E ILIFF AVE
Mailing Address - Street 2:SUITE 232
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6061
Mailing Address - Country:US
Mailing Address - Phone:303-758-2500
Mailing Address - Fax:303-757-7994
Practice Address - Street 1:4770 E ILIFF AVE
Practice Address - Street 2:SUITE 232
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6061
Practice Address - Country:US
Practice Address - Phone:303-758-2500
Practice Address - Fax:303-757-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19022103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Single Specialty