Individual
DR. EDITA EXTRA-MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1055 N. LA CANADA BLVD, SUITE 121, GREEN VALLEY, AZ 85614
(520) 547-7770
(520) 547-7775
Mailing address
5055 E BROADWAY BLVD, SUITE A100, TUCSON, AZ 85711
(520) 382-1205
(520) 795-0225
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24412
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
449787
—
AZ
01
—
Z145043
MEDICARE PTAN
AZ
Enumeration date
12/08/2005
Last updated
04/20/2017
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