Healthcare Provider Details

I. General information

NPI: 1356605877
Provider Name (Legal Business Name): GERONIMO MENDOZA URIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GERONIMO MENDOZA M.D.

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CUBA AVE
ALAMOGORDO NM
88310-5951
US

IV. Provider business mailing address

PO BOX 881
CLOUDCROFT NM
88317-0881
US

V. Phone/Fax

Practice location:
  • Phone: 575-554-5700
  • Fax: 866-611-2267
Mailing address:
  • Phone: 832-275-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10043455
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2015-0230
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberV7580
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: