Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1245992197 |
---|---|
Provider Name | Joel Mendoza JR. |
First Address | Aurora, CO 80011-6638 |
Second Address | Denver, CO 80205-5437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2021 |
Last Update Date | 07/10/2021 |