Provider Demographics
NPI:1518129378
Name:MENDIOLA, ANNA MARIE TEENA CAPULONG (MD)
Entity Type:Individual
Prefix:
First Name:ANNA MARIE TEENA
Middle Name:CAPULONG
Last Name:MENDIOLA
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 1:8061 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-4705
Mailing Address - Country:US
Mailing Address - Phone:915-859-7545
Mailing Address - Fax:915-859-9862
Practice Address - Street 1:8061 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-4705
Practice Address - Country:US
Practice Address - Phone:915-859-7545
Practice Address - Fax:915-859-9862
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10031884208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1831267079OtherGROUP NPI
TX130880104OtherGROUP MEDICAID
TX451901OtherGROUP MEDICARE
TX451901OtherGROUP MEDICARE