Provider Demographics
NPI:1366095911
Name:MENDEZ, HEIDI JANETTE
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JANETTE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 N LOS EBANOS RD STE 4
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:TX
Mailing Address - Zip Code:78573-1670
Mailing Address - Country:US
Mailing Address - Phone:956-478-1589
Mailing Address - Fax:956-271-1533
Practice Address - Street 1:8115 N LOS EBANOS RD STE 4
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-1670
Practice Address - Country:US
Practice Address - Phone:956-271-1535
Practice Address - Fax:956-271-1533
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320708064462081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine