MEDICARE: DR. HUMBERTO GERARDO 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1902284110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HUMBERTO GERARDO MENDOZA M.D.

Provider Business Mailing Address
First Line	:	267 GRANT STREET
Second Line	:	MED ED PODIUM 4
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-0120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	267 GRANT STREET
Second Line	:	MED ED PODIUM 4
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-0120
Country	:	US
Telephone Number	:	203-384-4442
Fax Number	:

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

Provider Enumeration Date	:	05/08/2015
Last Update Date	:	04/08/2024

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