Provider Demographics
NPI:1114915428
Name:MENDOZA, SONITA E (MD)
Entity Type:Individual
Prefix:
First Name:SONITA
Middle Name:E
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SONITA
Other - Middle Name:K
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:789 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-742-6664
Mailing Address - Fax:603-749-2461
Practice Address - Street 1:10 MEMBERS WAY
Practice Address - Street 2:SUITE 403
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-5933
Practice Address - Country:US
Practice Address - Phone:603-742-6664
Practice Address - Fax:603-749-2461
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11905207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3076283Medicaid
ME1114915428Medicaid
NH3076283Medicaid
NHRE745901Medicare PIN