Provider Demographics
NPI:1669840708
Name:MENDOZA, DAVID (MS, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:
Credentials:MS, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 34TH ST FL 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4744
Mailing Address - Country:US
Mailing Address - Phone:212-731-5388
Mailing Address - Fax:332-210-7570
Practice Address - Street 1:160 E 34TH ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4744
Practice Address - Country:US
Practice Address - Phone:212-731-5388
Practice Address - Fax:332-210-7570
Is Sole Proprietor?:No
Enumeration Date:2015-09-07
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307063-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health