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General NPI Number Information
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NPI Number | 1336801562
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Entity Type | Organization
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Legal Business Name | PHILLIP MENDOZA MD, LLC
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 20 S 5TH AVE STE D
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City | BRIGHTON
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State | CO
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Zip | 80601-2179
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Country | US
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Telephone | 303-960-7516
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Fax |
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Provider Business Mailing Address
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Address Line | 20 S 5TH AVE STE D
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City | BRIGHTON
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State | CO
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Zip | 80601-2179
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Country | US
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Telephone | 303-960-7516
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | PHILLIP MENDOZA
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Credential | MD
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Telephone | 303-960-7516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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