Provider Demographics
NPI:1336304054
Name:CORSO MENDOZA, GERMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GERMAN
Middle Name:
Last Name:CORSO 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 1:1901 S 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6533
Mailing Address - Country:US
Mailing Address - Phone:956-289-7025
Mailing Address - Fax:956-289-7257
Practice Address - Street 1:861 OLD ALICE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8551
Practice Address - Country:US
Practice Address - Phone:956-547-5400
Practice Address - Fax:956-289-7257
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP51662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R945OtherMEDICARE
TX138708613Medicaid
TX138708611Medicaid