Healthcare Provider Details

I. General information

NPI: 1962914572
Provider Name (Legal Business Name): ROBERTO MENDIOLA JR. RDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2017
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LOUIS HENNA BLVD APT 911
ROUND ROCK TX
78664-5741
US

IV. Provider business mailing address

646 S FLORES ST
SAN ANTONIO TX
78204-1219
US

V. Phone/Fax

Practice location:
  • Phone: 956-434-6154
  • Fax:
Mailing address:
  • Phone: 855-481-1149
  • Fax: 855-710-7869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: