Provider Demographics
NPI:1881995462
Name:MENDOZA, LORETA A (MD)
Entity type:Individual
Prefix:DR
First Name:LORETA
Middle Name:A
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LORETA
Other - Middle Name:
Other - Last Name:GALUTERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M,D
Mailing Address - Street 1:11845 CRESTA VERDE DR
Mailing Address - Street 2:APTC
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4746
Mailing Address - Country:US
Mailing Address - Phone:314-997-5997
Mailing Address - Fax:
Practice Address - Street 1:1034 S BRENTWOOD BLVD STE 1250
Practice Address - Street 2:FOREST PARK MEDICAL CLINIC
Practice Address - City:ST,LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1263
Practice Address - Country:US
Practice Address - Phone:314-367-6600
Practice Address - Fax:314-367-5982
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34045261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service