Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | K4572 | TX |
N | 2084N0600X | Clinical Neurophysiologist | K4572 | TX |
NPI | 1235294695 |
---|---|
Provider Name | Dr. Gerald Mendoza So |
First Address | Plano, TX 75024-7733 |
Second Address | Plano, TX 75024-7733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 18/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G56045 | (02) |