MEDICARE: DANIEL MENDOZA REQUENA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	Q2927	TX

General Provider Information

NPI Number	:	1063626455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MENDOZA REQUENA MD

Provider Business Mailing Address
First Line	:	2700 CULLEN BLVD UNIT 841696
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-0838
Country	:	US
Telephone Number	:	713-955-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	2734 SUNRISE BLVD STE 311
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-8709
Country	:	US
Telephone Number	:	281-858-3904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	10/06/2022

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