Provider Demographics
NPI:1841616729
Name:MENDOZA, ALEXANDRA CAIN (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CAIN
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:NICOLE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:6621 FANNIN ST # MCA2270
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2358
Mailing Address - Country:US
Mailing Address - Phone:832-828-6507
Mailing Address - Fax:832-825-0872
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2608
Practice Address - Country:US
Practice Address - Phone:832-824-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09026363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330773801Medicaid