NPIMap

Organization Active NPI

Mendoza Medical Clinic

  • Pediatrics Physician
  • Kenner, LA
National Provider Identifier
1073839759
Registry record updated Sep 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MENDOZA MEDICAL CLINIC
Practice address
3100 Williams Blvd
Kenner, LA 70065
Phone
(504) 443-1744
NPI assigned
Apr 20, 2010
Last updated
Sep 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Roberto Clemente Mendoza, M.D
Title
Owner
Phone
(504) 443-1744

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

3100 Williams Blvd
Kenner, LA 70065

Mailing address

3100 Williams Blvd
Kenner, LA 70065-4505
Phone (504) 443-1744

Other identifiers 2

IdentifierTypeStateIssuer
2118099MedicaidLA
1191272MedicaidLA

Other names 1

  • Roberto C Mendoza,M.D.APMC Former legal business name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0919005Mendoza Medical3100 Williams Boulevard, Kenner, LA 70065Certificate of waiverAug 25, 2026

National Provider Directory

National Provider Directory

Locations

3100 Williams Blvd
Kenner, LA 70065
Phone (504) 443-1744

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316649600000",
    "number": "1073839759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 WILLIAMS BLVD",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700654505",
            "telephone_number": "504-443-1744",
            "fax_number": "504-443-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 WILLIAMS BLVD",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "70065",
            "telephone_number": "504-443-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOZA MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2011-09-22",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "ROBERTO",
        "authorized_official_middle_name": "CLEMENTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-443-1744",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2118099",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1191272",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roberto C Mendoza,M.D.APMC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kenner, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.