Provider Demographics
NPI:1033710074
Name:MENDIOLA, BROOKE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MENDIOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 OAKWELL FARMS PKWY STE 257
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1736
Mailing Address - Country:US
Mailing Address - Phone:210-930-8400
Mailing Address - Fax:210-930-8402
Practice Address - Street 1:1919 OAKWELL FARMS PKWY STE 257
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-1736
Practice Address - Country:US
Practice Address - Phone:210-930-8400
Practice Address - Fax:210-930-8402
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1013656363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics