MEDICARE: MS. TRICIA POBLETE MENDOZA M.D.

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	2084P0800X	Psychiatry Physician	246874	NY
2	2084P0805X	Geriatric Psychiatry Physician	14388	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14388	OTHER	NH	NH LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568648897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRICIA POBLETE MENDOZA M.D.

Provider Business Mailing Address
First Line	:	20 LADD STREET
Second Line	:	SUITE 404
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801
Country	:	US
Telephone Number	:	603-205-2953
Fax Number	:	603-433-6341

Provider Business Practice Location Address
First Line	:	333 BORTHWICK AVE STE 100
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4198
Country	:	US
Telephone Number	:	603-436-5110
Fax Number	:

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

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	02/12/2024

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