Provider Demographics
NPI:1326086638
Name:MENDOZA, ALEJANDRO Y (MD)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:Y
Last Name:MENDOZA
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 1:3 CLARA HOWARD WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1024
Mailing Address - Country:US
Mailing Address - Phone:508-427-3000
Mailing Address - Fax:
Practice Address - Street 1:235 NORTH PEARL STREET
Practice Address - Street 2:CARITAS GOOD SAMARITAN MED CTR
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-427-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA747292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ11608OtherBLUE CROSS
MA22037OtherHEALTHNET
MA3082725Medicaid
MA006271OtherHARVARD PILGRIM
MA0025189OtherNEIGHBORHOOD HEALTH PLAN
MA731509OtherTUFTS
MA0025189OtherNEIGHBORHOOD HEALTH PLAN
MAJ11608Medicare PIN