Provider Demographics
NPI:1578322533
Name:MENDEZ, ISAAC S SR (MT123658)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:S
Last Name:MENDEZ
Suffix:SR
Gender:M
Credentials:MT123658
Other - Prefix:MR
Other - First Name:ISAAC
Other - Middle Name:S
Other - Last Name:MENDEZ
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MT123658
Mailing Address - Street 1:3330 AUDLEY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1943
Mailing Address - Country:US
Mailing Address - Phone:281-753-1475
Mailing Address - Fax:
Practice Address - Street 1:3930 GIBSON ST # B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5763
Practice Address - Country:US
Practice Address - Phone:281-888-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT123658225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist