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General NPI Number Information
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NPI Number | 1215894522
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Entity Type | Organization
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Legal Business Name | MJ MENDIZABAL PA-C MMS, P.C
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 422 N NORTHWEST HWY STE B2
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City | PARK RIDGE
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State | IL
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Zip | 60068-3272
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Country | US
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Telephone | 773-984-1494
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Fax | 773-904-1919
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Provider Business Mailing Address
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Address Line | 422 N NORTHWEST HWY STE B2
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City | PARK RIDGE
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State | IL
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Zip | 60068-3272
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Country | US
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Telephone | 773-984-1494
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Fax | 773-904-1919
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY JEAN MENDIZABAL
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Credential | PA-C
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Telephone | 773-984-1494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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