Provider Demographics
NPI:1821678905
Name:MENDIOLA, RICARDO A (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:A
Last Name:MENDIOLA
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 452268
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-516-7304
Mailing Address - Fax:
Practice Address - Street 1:6262 MCPHERSON RD STE 104
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6183
Practice Address - Country:US
Practice Address - Phone:956-516-7304
Practice Address - Fax:956-516-7301
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034439363LP0808X
RIAPRN02717363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health