MEDICARE: DR. RAUL MENDOZA M.D.

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	207RC0000X	Cardiovascular Disease Physician	171383	NY

General Provider Information

NPI Number	:	1457357667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAUL MENDOZA M.D.

Provider Business Mailing Address
First Line	:	48 HAMILTON ST
Second Line	:
City	:	ROCKVILLE CENTRE
State	:	NY
Zip	:	11570-2037
Country	:	US
Telephone Number	:	516-594-1173
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 ROCKAWAY TPKE
Second Line	:	STE 103
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1023
Country	:	US
Telephone Number	:	516-239-1616
Fax Number	:	516-239-2566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/23/2013

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