Provider Demographics
NPI:1417302332
Name:ESPANOL MENDEZ, MARIA GABRIELA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GABRIELA
Last Name:ESPANOL MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 W NORTHMOOR RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-3542
Mailing Address - Country:US
Mailing Address - Phone:309-692-5337
Mailing Address - Fax:309-693-3913
Practice Address - Street 1:427 W NORTHMOOR RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-3542
Practice Address - Country:US
Practice Address - Phone:309-692-5337
Practice Address - Fax:309-693-3913
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL0361586332080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program