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General NPI Number Information
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NPI Number | 1396524054
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Entity Type | Organization
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Legal Business Name | MENDIVIL CLINIC FOR FOOT & ANKLE
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Dates
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Enumeration Date | 09/22/2023
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 11621 PELLICANO DR
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City | EL PASO
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State | TX
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Zip | 79936-6242
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Country | US
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Telephone | 915-206-5044
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Fax |
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Provider Business Mailing Address
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Address Line | 12339 CHIANTI DR
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City | EL PASO
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State | TX
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Zip | 79928-8644
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JASON MENDIVIL
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Credential | DPM
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Telephone | 915-309-0513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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