Healthcare Provider Details

I. General information

NPI: 1043394414
Provider Name (Legal Business Name): JOHN EDMUND MENDOZA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PERDIDO ST 10G
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

3928 S INWOOD AVE
NEW ORLEANS LA
70131
US

V. Phone/Fax

Practice location:
  • Phone: 504-585-2970
  • Fax:
Mailing address:
  • Phone: 504-394-8531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number466
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number466
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: