# DR. MENDOZA'S PEDIATRIC AND ADOLSCENT

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295908101
- **Authorized official:** EDGAR ALLEN MENDOZA MD (OWNER)
- **Authorized official phone:** (606) 693-4800

## Contact information

- **Practice address:** 424 JETT DR, JACKSON, KY 41339-9621
- **Practice address phone:** (606) 693-4800
- **Practice address fax:** (606) 693-4825
- **Mailing address:** PO BOX 790, JACKSON, KY 41339-0790
- **Mailing address phone:** (606) 693-4800
- **Mailing address fax:** (606) 693-4825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | 33465 | KY | Yes |

## Other

- **Enumeration date:** 04/11/2008
- **Last updated:** 07/10/2014