Provider Demographics
NPI:1255770400
Name:MENDEZ, ILEANA E (MD)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:E
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E TORONTO AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1209
Mailing Address - Country:US
Mailing Address - Phone:956-687-6155
Mailing Address - Fax:956-618-0451
Practice Address - Street 1:205 E TORONTO AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1209
Practice Address - Country:US
Practice Address - Phone:956-687-6155
Practice Address - Fax:956-618-0451
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN54525207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program