Provider Demographics
NPI:1235576455
Name:MENDOZA, PATRICK LAWRENCE
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LAWRENCE
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 SCARSDALE RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10707-1604
Mailing Address - Country:US
Mailing Address - Phone:914-771-9414
Mailing Address - Fax:
Practice Address - Street 1:226 LINDA AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2018
Practice Address - Country:US
Practice Address - Phone:914-773-7314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program