Provider Demographics
NPI:1619572997
Name:ASTUDILLO, ROBERTO MENDOZA
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:MENDOZA
Last Name:ASTUDILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3222
Mailing Address - Country:US
Mailing Address - Phone:650-579-7881
Mailing Address - Fax:650-579-2640
Practice Address - Street 1:114 S DELAWARE ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3222
Practice Address - Country:US
Practice Address - Phone:650-579-7881
Practice Address - Fax:650-579-2640
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other