MEDICARE: DR. FRANCISCO GUADALUPE MENDIVIL MORENO DPM

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	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	E5452	CA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E5452	CA

General Provider Information

NPI Number	:	1871989475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANCISCO GUADALUPE MENDIVIL MORENO DPM

Provider Business Mailing Address
First Line	:	1226 W TAYLOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4709
Country	:	US
Telephone Number	:	909-499-2625
Fax Number	:

Provider Business Practice Location Address
First Line	:	728 N EUCLID AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-2712
Country	:	US
Telephone Number	:	909-984-5614
Fax Number	:

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

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	10/17/2024

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