Individual
NELIA MENDOZA SAN JOSE-CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
420 HUDGINS RD, SUITE 204, FREDERICKSBURG, VA 22408-4172
(814) 591-8455
Mailing address
6000 HAMS CT, WOODFORD, VA 22580-9646
(814) 591-8455
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0101245684
VA
2084P0800X
Psychiatry Physician
MDO67980L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017557270002
—
PA
01
—
008450693
HIGHMARK BC/BS
PA
01
—
5624399
FIRST HEALTH PROVIDER #
PA
Enumeration date
06/29/2006
Last updated
04/14/2010
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