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General NPI Number Information
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NPI Number | 1255374856
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Entity Type | Individual
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Provider Name | DAVID C. MENDOZA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 604 ANN ST
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City | PARKERSBURG
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State | WV
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Zip | 26101-5122
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Country | US
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Telephone | 304-865-5155
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Fax | 304-865-5156
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Provider Business Mailing Address
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Address Line | 600 18TH ST SUITE 303
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City | PARKERSBURG
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State | WV
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Zip | 26101-3231
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Country | US
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Telephone | 304-424-4593
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Fax | 304-424-4017
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 18562
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License Number State | WV
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