MEDICARE: ERNEST MENDOZA, MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033190111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERNEST MENDOZA, MD PA

Provider Business Mailing Address
First Line	:	1330 KINGWOOD DR
Second Line	:	SUITE 100
City	:	HUMBLE
State	:	TX
Zip	:	77339-3038
Country	:	US
Telephone Number	:	281-361-6500
Fax Number	:	281-361-6501

Provider Business Practice Location Address
First Line	:	1330 KINGWOOD DR
Second Line	:	SUITE 100
City	:	HUMBLE
State	:	TX
Zip	:	77339-3038
Country	:	US
Telephone Number	:	281-361-6500
Fax Number	:	281-361-6501

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERNEST J MENDOZA
Credential	:	M.D.
Telephone Number	:	281-361-6500

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/03/2007

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