Provider Demographics
NPI:1427582055
Name:MENDOZA, FERDINAND
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:
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 1:2953 SECLUSION COVE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2453
Mailing Address - Country:US
Mailing Address - Phone:907-952-1180
Mailing Address - Fax:907-677-2072
Practice Address - Street 1:2953 SECLUSION COVE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2453
Practice Address - Country:US
Practice Address - Phone:907-952-1180
Practice Address - Fax:907-677-2072
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16-618246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant