MEDICARE: MARLON ANTHONY MENDOZA 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	208000000X	Pediatrics Physician	10601	NV

General Provider Information

NPI Number	:	1861454514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLON ANTHONY MENDOZA MD

Provider Business Mailing Address
First Line	:	PO BOX 26568
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89126-0568
Country	:	US
Telephone Number	:	702-331-1700
Fax Number	:	702-818-5013

Provider Business Practice Location Address
First Line	:	5781 W SAHARA AVE STE 500
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3168
Country	:	US
Telephone Number	:	702-331-1700
Fax Number	:	702-818-5013

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	04/30/2018

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