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General NPI Number Information
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NPI Number | 1225011950
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Entity Type | Individual
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Provider Name | LUIS A MENDOZA MD
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Gender | Male
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 289 MONROE ST
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City | PASSAIC
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State | NJ
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Zip | 07055-5209
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Country | US
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Telephone | 973-473-5151
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Fax | 973-473-3331
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Provider Business Mailing Address
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Address Line | PO BOX 1758
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City | CLIFTON
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State | NJ
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Zip | 07015-1758
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Country | US
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Telephone | 973-473-5151
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Fax | 973-473-3331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA02404700
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License Number State | NJ
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