Provider Demographics
NPI:1063665651
Name:MENDOZA, OSCAR G III (AA)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:G
Last Name:MENDOZA
Suffix:III
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 UPLAND DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4718
Mailing Address - Country:US
Mailing Address - Phone:305-205-4701
Mailing Address - Fax:727-443-4206
Practice Address - Street 1:1755 CURIE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2919
Practice Address - Country:US
Practice Address - Phone:305-205-4701
Practice Address - Fax:727-443-4206
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA24367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant