Healthcare Provider Details

I. General information

NPI: 1417302332
Provider Name (Legal Business Name): MARIA GABRIELA ESPANOL MENDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 07/03/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 S 1-10 SERVICE RD SUITE 401
METAIRIE LA
70001
US

IV. Provider business mailing address

427 W NORTHMOOR RD
PEORIA IL
61614-3542
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5433
  • Fax:
Mailing address:
  • Phone: 309-692-5337
  • Fax: 309-693-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number036158633
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number320681
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: