Provider Demographics
NPI:1780714303
Name:MENDIOLA, RAQUEL (RD)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:
Last Name:MENDIOLA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5622
Mailing Address - Country:US
Mailing Address - Phone:915-887-3410
Mailing Address - Fax:915-592-7168
Practice Address - Street 1:1477 LOMALAND DR STE E7
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4704
Practice Address - Country:US
Practice Address - Phone:915-599-6690
Practice Address - Fax:915-592-7168
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07359133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174792501Medicaid