Healthcare Provider Details

I. General information

NPI: 1295922425
Provider Name (Legal Business Name): PAOLA MARIA L MENDOZA-SENGCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 5021
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE ML 4009
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7480
  • Fax: 513-636-7360
Mailing address:
  • Phone: 513-636-7480
  • Fax: 513-636-7360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number32586
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number35.137491
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32586
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: