Individual
EDISON V MENDOZA DELA PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9429 BAY COLONY DR, DES PLAINES, IL 60016-3623
(224) 619-0724
Mailing address
9429 BAY COLONY DR APT 1S, DES PLAINES, IL 60016-3623
(224) 619-0724
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D41521302250
IL
Other
Enumeration date
12/13/2021
Last updated
12/13/2021
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