Healthcare Provider Details

I. General information

NPI: 1619429404
Provider Name (Legal Business Name): RAFAEL JACINTO MENDOZA-PRADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

IV. Provider business mailing address

205 E TORONTO AVE
MCALLEN TX
78503-1209
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-6155
  • Fax:
Mailing address:
  • Phone: 956-687-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV3910
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberSA000718
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: