Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | E5452 | CA |
NPI | 1871989475 |
---|---|
Provider Name | Dr. Francisco Guadalupe Mendivil Moreno |
First Address | Chicago, IL 60607-4709 |
Second Address | Ontario, CA 91762-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 13/06/2019 |