Healthcare Provider Details

I. General information

NPI: 1063746014
Provider Name (Legal Business Name): DARO MENDOZA LARGOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MENDARO MENDOZA LARGOZA MD

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WEST 34TH. ST. 15B10
NEW YORK NY
10001-2636
US

IV. Provider business mailing address

50 W 34TH ST APT 15B10
NEW YORK NY
10001-3086
US

V. Phone/Fax

Practice location:
  • Phone: 347-526-1810
  • Fax:
Mailing address:
  • Phone: 347-526-1810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number226955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: