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NPI Code Detail

MEDICARE: DR. OMAR MENDOZA M.D.

MEDICARE: DR. OMAR 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
1207P00000XEmergency Medicine Physician204682CA
2207P00000XEmergency Medicine Physician33157AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619977261
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OMAR MENDOZA M.D.
Provider Business Mailing Address
First Line : 4636 CAPLES CIR
Second Line :
City : EL PASO
State : TX
Zip : 79903-1511
Country : US
Telephone Number : 915-881-4961
Fax Number :
Provider Business Practice Location Address
First Line : 1171 W TARGET RANGE RD
Second Line :
City : NOGALES
State : AZ
Zip : 85621-2415
Country : US
Telephone Number : 520-285-8020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 10/01/2025

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