Individual
MR. MYCHAEL DENNIS MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4320 SEMINARY RD, ALEXANDRIA, VA 22304-1535
(703) 766-9699
Mailing address
68 S SERVICE RD, SUOTE 350, MELVILLE, NY 11747-2358
(516) 945-3000
(516) 945-3131
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024168164
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194964213
—
VA
Enumeration date
02/12/2009
Last updated
03/20/2015
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