Active NPI
Juan Mendoza
- Addiction (Substance Use Disorder) Psychologist
- Las Cruces, NM
National Provider Identifier
1326420951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Psychologist
- License
- 0169701
- Practice address
- 715 E. Idaho
Las Cruces, NM 88007 - Phone
- (575) 524-2505
- NPI assigned
- Jun 19, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | 0169701 | NM | Primary |
Addresses
Primary practice location
715 E. Idaho
Las Cruces, NM 88007
Mailing address
4939 Sherwood Dr.
Las Cruces, NM 88012
Phone (575) 524-2505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0169701 | NM | MD | Addiction (Substance Use Disorder) Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434672000000",
"number": "1326420951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4939 SHERWOOD DR.",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "88012",
"telephone_number": "575-524-2505"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 E. IDAHO",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "88007",
"telephone_number": "575-524-2505"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "JUAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-19",
"last_updated": "2015-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "103TA0400X",
"taxonomy_group": "",
"desc": "Psychologist, Addiction (Substance Use Disorder)",
"state": "NM",
"license": "0169701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.