Provider Demographics
NPI:1790389757
Name:MENDIOLA FAMILY HEALTHCARE PLLC
Entity Type:Organization
Organization Name:MENDIOLA FAMILY HEALTHCARE PLLC
Other - Org Name:VICTOR MENDIOLA MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:832-304-2007
Mailing Address - Street 1:427 W 27TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2010
Mailing Address - Country:US
Mailing Address - Phone:832-304-2007
Mailing Address - Fax:832-304-2005
Practice Address - Street 1:427 W 20TH ST STE 303
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2429
Practice Address - Country:US
Practice Address - Phone:713-697-4705
Practice Address - Fax:713-697-4763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127001904Medicaid