Healthcare Provider Details

I. General information

NPI: 1891437851
Provider Name (Legal Business Name): FIORELLA YEP MENDIZABAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 RED RIVER ST
AUSTIN TX
78701-1918
US

IV. Provider business mailing address

333 N PENNSYLVANIA ST UNIT 207
INDIANAPOLIS IN
46204-3367
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-7390
  • Fax:
Mailing address:
  • Phone: 260-443-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10078578
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: