Extra-Mendoza, Edita

Extra-Mendoza, Edita is an individual health care provider with primary practice located at 1055 N. La Canada Blvd Suite 121, Green Valley AZ 85614. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Extra-Mendoza, Edita can be contacted via phone (520) 547-7770.

Contact Information

Primary practice address
1055 N. La Canada Blvd Suite 121 Green Valley AZ 85614
Phone: (520) 547-7770
Fax: (520) 547-7775
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 24412 Arizona

Profile Details

NPI number 1326023839
LBN Legal business name Extra-Mendoza, Edita
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 8th, 2005
Last updated Apr 20th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326023839 NPPES
Arizona MEDICAID 449787
Arizona Other Z145043

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