Provider Demographics
NPI:1073149522
Name:MENDOZA, DANILO JR (APRN, ACCNS-AG, CCRN)
Entity Type:Individual
Prefix:MR
First Name:DANILO
Middle Name:
Last Name:MENDOZA
Suffix:JR
Gender:M
Credentials:APRN, ACCNS-AG, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 12TH ST S
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4819
Mailing Address - Country:US
Mailing Address - Phone:310-926-4439
Mailing Address - Fax:
Practice Address - Street 1:8901 ROCKVILLE PIKE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-2111
Practice Address - Country:US
Practice Address - Phone:301-295-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN590317163WC0200X
CA725631163WC0200X
TX800475163WC0200X
CA4696364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine