Provider Demographics
NPI:1609575588
Name:MENDIRATTA, AYUSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:AYUSHI
Middle Name:
Last Name:MENDIRATTA
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 1:400W 16TH ST
Mailing Address - Street 2:PARKVIEW MEDICAL CENTER GME OFFICE
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003
Mailing Address - Country:US
Mailing Address - Phone:719-584-4000
Mailing Address - Fax:
Practice Address - Street 1:311 WEST 14TH STREET
Practice Address - Street 2:PARKVIEW MEDICAL CENTER PARKVIEW ADULT MEDICINE CLINIC
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003
Practice Address - Country:US
Practice Address - Phone:719-595-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0009520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine