Healthcare Provider Details

I. General information

NPI: 1831880038
Provider Name (Legal Business Name): LOIS MENDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S COULTER ST
AMARILLO TX
79106-1786
US

IV. Provider business mailing address

1400 S COULTER ST STE 5100
AMARILLO TX
79106-1786
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-9654
  • Fax:
Mailing address:
  • Phone: 806-414-9559
  • Fax: 806-351-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP2-0086668
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: