Harold Lisandro Mendoza Moreno, RSA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

238.000377 Issued in IL

Practice address

26536 W Countryside LN
Plainfield, IL 60585-2324

Phone

(630) 258-0401

Fax

(779) 234-9841

NPI assigned

Oct 4, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Global Surgical Solutions-Professional Limited Liability Com

  • Surgical Physician Assistant
  • Plainfield, IL
  • NPI 1124762554
  NPD Authorized official

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

{
    "created_epoch": "1380844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1366879330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 163",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605430163",
            "telephone_number": "630-258-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26536 W COUNTRYSIDE LN",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "605852324",
            "telephone_number": "630-258-0401",
            "fax_number": "779-234-9841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA MORENO",
        "first_name": "HAROLD",
        "middle_name": "LISANDRO",
        "credential": "RSA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-04",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "238.000377",
            "primary": true
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "IL",
            "license": "238.000377",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meijer Great Lakes Limited Partnership
• Helen H Meil, JD, LCPC, CADC
• Karen Lilian Mejia
• Michlene Melahn, DC
• Ruslana Menasce
• Frida A Meraz, RBT
• Brianna Mesenbring, CNS, LDN
• Rebecca Metcalfe
• Kellie Meyn
• Aimee Micetic, MA, LCPC

• Surgical Physician Assistant in Plainfield, IL
• Providers in Plainfield, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.