Healthcare Provider Details

I. General information

NPI: 1639719297
Provider Name (Legal Business Name): CATHERINE ANTOINETTE MENDOZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2020
Last Update Date: 01/26/2020
Certification Date: 01/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11920 ASTORIA BLVD STE 320
HOUSTON TX
77089-6097
US

IV. Provider business mailing address

11920 ASTORIA BLVD STE 320
HOUSTON TX
77089-6097
US

V. Phone/Fax

Practice location:
  • Phone: 281-484-9369
  • Fax: 281-484-1843
Mailing address:
  • Phone: 281-484-9369
  • Fax: 281-484-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP138838
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: