Provider Demographics
NPI:1184929333
Name:CARBAJAL MENDOZA, ROGER FRANCISCO (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:FRANCISCO
Last Name:CARBAJAL MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12234 SHADOW CREEK PKWY STE 5104
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7334
Mailing Address - Country:US
Mailing Address - Phone:347-785-6943
Mailing Address - Fax:
Practice Address - Street 1:10023 S. MAIN
Practice Address - Street 2:C-9
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025
Practice Address - Country:US
Practice Address - Phone:713-791-1633
Practice Address - Fax:713-791-1710
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003707207RN0300X
TXP0559208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03313628Medicaid
NY03313628Medicaid