Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 35139232 | OH |
NPI | 1033599055 |
---|---|
Provider Name | Kristen Ann V. Mendoza |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43212-3153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0410154 | (05) | OH |