Provider Demographics
NPI:1386710523
Name:MENDOZA MEDICAL LLC
Entity type:Organization
Organization Name:MENDOZA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:520-593-7761
Mailing Address - Street 1:1751 W ORANGE GROVE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1192
Mailing Address - Country:US
Mailing Address - Phone:520-593-7761
Mailing Address - Fax:520-593-7764
Practice Address - Street 1:1751 W ORANGE GROVE RD STE 111
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1192
Practice Address - Country:US
Practice Address - Phone:520-593-7761
Practice Address - Fax:520-593-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0300X
AZ35869261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ111992Medicare PIN