Healthcare Provider Details

I. General information

NPI: 1194201426
Provider Name (Legal Business Name): RICARDO CEDENO-MENDOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FIRE MESA ST # 120
LAS VEGAS NV
89128-9009
US

IV. Provider business mailing address

8379 W SUNSET RD STE 210
LAS VEGAS NV
89113-2243
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-2437
  • Fax: 702-479-1796
Mailing address:
  • Phone: 702-968-2437
  • Fax: 702-479-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number21888
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number21888
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: