Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | Q2927 | TX |
NPI | 1063626455 |
---|---|
Provider Name | Daniel Mendoza Requena |
First Address | Pearland, TX 77584-0838 |
Second Address | Pearland, TX 77584-8709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 30/01/2020 |