Provider Demographics
NPI:1649491648
Name:MENDEZ-CANCEL, RODOLFO (MD)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:MENDEZ-CANCEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 MEMORIAL DR
Mailing Address - Street 2:F501
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8021
Mailing Address - Country:US
Mailing Address - Phone:713-805-5870
Mailing Address - Fax:713-805-5870
Practice Address - Street 1:5535 MEMORIAL DR
Practice Address - Street 2:F501
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8021
Practice Address - Country:US
Practice Address - Phone:713-805-5870
Practice Address - Fax:713-805-5870
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121424902Medicaid
TX0001ARMedicare PIN
TXG33593Medicare UPIN