Healthcare Provider Details

I. General information

NPI: 1699118307
Provider Name (Legal Business Name): JOSE AMERICO MENDOZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 02/01/2023
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HARBORSIDE DR STE 105-107
GALVESTON TX
77555-0001
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-6509
US

V. Phone/Fax

Practice location:
  • Phone: 409-747-1883
  • Fax:
Mailing address:
  • Phone: 409-747-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR0452
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberR0452
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: