Individual
HAROLD LISANDRO MENDOZA MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RSA
Contact information
Practice address
26536 W COUNTRYSIDE LN, PLAINFIELD, IL 60585-2324
(630) 258-0401
(779) 234-9841
Mailing address
PO BOX 163, OSWEGO, IL 60543-0163
(630) 258-0401
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
238.000377
IL
363AS0400X
Surgical Physician Assistant
Primary
238.000377
IL
Other
Enumeration date
10/04/2013
Last updated
03/19/2024
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