Healthcare Provider Details

I. General information

NPI: 1023171683
Provider Name (Legal Business Name): JASON ANTHONY MENDOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE HMC DEPARTMENT OF PEDIATRICS - BOX 359774
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE HMC DEPARTMENT OF PEDIATRICS - BOX 359774
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9500
  • Fax: 206-744-9862
Mailing address:
  • Phone: 206-744-9500
  • Fax: 206-744-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 00043582
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: