Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 25824 | TX |
Y | 1223E0200X | Endodontist | 25824 | TX |
NPI | 1063726198 |
---|---|
Provider Name | Dr. Paula Andrea Mendez Montalvo |
First Address | Sugarland, TX 77479 |
Second Address | Sugarland, TX 77479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2010 |
Last Update Date | 29/08/2018 |