Provider Demographics
NPI:1144226242
Name:MENDEZ, ANGELO C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:C
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W COLLEGE ST
Mailing Address - Street 2:STE 340
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3577
Mailing Address - Country:US
Mailing Address - Phone:817-329-0389
Mailing Address - Fax:817-421-1416
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:STE 340
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3577
Practice Address - Country:US
Practice Address - Phone:817-329-0389
Practice Address - Fax:817-421-1416
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5371207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QI68Medicare ID - Type Unspecified
TXC19290Medicare UPIN