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General NPI Number Information
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NPI Number | 1265745491
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Entity Type | Individual
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Provider Name | MICHAEL VINCENT SANTOTOME MENDOZA M.D
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Gender | Male
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 285 BOULEVARD NE STE 415
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City | ATLANTA
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State | GA
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Zip | 30312-4210
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Country | US
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Telephone | 404-265-4400
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Fax | 404-265-4452
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Provider Business Mailing Address
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Address Line | 285 BOULEVARD NE SUITE 415
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City | ATLANTA
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State | GA
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Zip | 30312
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Country | US
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Telephone | 404-265-4400
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Fax | 404-265-4452
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 073365
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 073365
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | 073365
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License Number State | GA
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