Individual
DR. CIRIACO ADA MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
122 12TH STREET EXT, PRINCETON, WV 24740-2352
(304) 487-7000
Mailing address
PO BOX 634715, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
13884
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000699368
BLUE CROSS
WV
05
—
0052156-000
—
WV
01
—
1044421
WORKERS COMP
WV
01
—
P00048451
MEDICARE RAILROAD
WV
Enumeration date
06/09/2006
Last updated
11/09/2007
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