Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | RN1049423 | DC |
NPI | 1023597671 |
---|---|
Provider Name | Dr. Joseph Albert Mendiola |
First Address | Burtonsville, MD 20866-1935 |
Second Address | Washington, DC 20010-3017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 13/08/2018 |