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General NPI Number Information
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NPI Number | 1831127992
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Entity Type | Individual
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Provider Name | NELIA MENDOZA SAN JOSE-CARLSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 420 HUDGINS RD SUITE 204
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-4172
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Country | US
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Telephone | 814-591-8455
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 HAMS CT
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City | WOODFORD
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State | VA
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Zip | 22580-9646
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Country | US
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Telephone | 814-591-8455
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101245684
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MDO67980L
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License Number State | PA
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