Provider Demographics
NPI:1568446748
Name:MENDOZA, RUBEN V (MD, PA)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:V
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CARE CIR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2118
Mailing Address - Country:US
Mailing Address - Phone:806-354-8300
Mailing Address - Fax:806-354-9962
Practice Address - Street 1:22 CARE CIR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2118
Practice Address - Country:US
Practice Address - Phone:806-354-8300
Practice Address - Fax:806-354-9962
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL13912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140834601Medicaid
TX140834602Medicaid
TX127378105Medicaid
TX140834608Medicaid
TX8276NOMedicare PIN
TX127378105Medicaid