Provider Demographics
NPI:1609980499
Name:MENDOZA, BERNARDO (MD)
Entity Type:Individual
Prefix:
First Name:BERNARDO
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 N CAMPBELL AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1563
Mailing Address - Country:US
Mailing Address - Phone:520-320-3819
Mailing Address - Fax:520-629-9430
Practice Address - Street 1:1815 W SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2653
Practice Address - Country:US
Practice Address - Phone:520-834-4289
Practice Address - Fax:520-628-4863
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0469242086S0129X
AZ336862086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1609980499Medicaid
P00250971OtherTRAVELERS MC
300051634OtherONE HEALTHPLAN
935520OtherAPIPA
0829457OtherCIGNA
P00250971OtherRR MC PIN
AZ300051634OtherHEALTH PLAN AHP
300061534OtherMARICOPA FOUND
93520OtherAHCCCS
DD0379OtherRR MC GRP
300051634OtherPACIFICARE
300051634OtherHUMANA
935520OtherINDIAN HEALTH
AZ935520Medicaid
7775720OtherAETNA
935520001OtherMERCY CARE
1Z9863OtherINTERGROUP HEALTHNET
AZAZ0778710OtherBCBS
935520001OtherMERCY CARE
935520OtherINDIAN HEALTH
P00250971OtherTRAVELERS MC
CT1609980499Medicaid