Provider Demographics
NPI:1467629667
Name:MENDIOLA, LAURA LETICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LETICIA
Last Name:MENDIOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1119 FENWICK DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2971
Mailing Address - Country:US
Mailing Address - Phone:956-652-4321
Mailing Address - Fax:888-872-3909
Practice Address - Street 1:1119 FENWICK DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2971
Practice Address - Country:US
Practice Address - Phone:956-652-4321
Practice Address - Fax:888-872-3909
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN9744207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286628701Medicaid
TX286628701Medicaid