Provider Demographics
NPI:1861769598
Name:MENDOZA, PEDRO ALBERTO (AGACNP)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:ALBERTO
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8608 SPINDLETOP DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-2001
Mailing Address - Country:US
Mailing Address - Phone:915-274-2868
Mailing Address - Fax:
Practice Address - Street 1:707 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3409
Practice Address - Country:US
Practice Address - Phone:307-527-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705297163W00000X
CT222969363LA2100X
CA95023815363LA2100X
TXAP120223363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX705297OtherRN LICENSE
TXAP120223OtherNURSE PRACTITIONER LICENSE
CT222969OtherNURSE PRACTITIONER LICENSE
CA95023815OtherACNP