Organization
RICO VINCENTE. I. MENDOZA,MD,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DARLA M BROWN RRT (OFFICE MANAGER)
(864) 582-6858
Entity
Organization
Contact information
Practice address
2030 NORTH CHURCH PLACE, SPARTANBURG, SC 29303-2706
(864) 582-6858
(864) 585-0999
Mailing address
PO BOX 4276, SPARTANBURG, SC 29305-4276
(864) 582-6858
(864) 585-0999
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
23156
SC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
23156
SC
207RP1001X
Pulmonary Disease Physician
23156
SC
207RS0012X
Sleep Medicine (Internal Medicine) Physician
23156
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231564
—
SC
01
—
8688
MBPG'S
SC
01
—
DF9437
RAILROAD MEDICARE
SC
Enumeration date
02/07/2007
Last updated
12/19/2012
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