Individual
JOSE KIAMCO MENDOZA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4502 HIGHWAY 951, JACKSON, LA 70748-5103
(225) 634-4820
(225) 634-0489
Mailing address
4502 HIGHWAY 951, JACKSON, LA 70748-5103
(225) 634-4820
(225) 634-0489
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
023159
LA
208M00000X
Hospitalist Physician
023159
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0542328
—
MS
05
—
1497371
—
LA
01
—
P00020217
RAIL ROAD MEDICARE
LA
Enumeration date
08/09/2005
Last updated
11/02/2023
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