Maxine Mendoza, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA00418 Issued in TX

Practice address

2600 W Neal St
Commerce, TX 75428-4311

Phone

(903) 886-5853

Fax

(903) 886-5854

NPI assigned

Jul 29, 2005

Last updated

Apr 11, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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

• Texas a&M University Commerce

  • Clinic/Center
  • Commerce, TX
  • NPI 1407286396
  NPD (past) Authorized official
• Texas a&M Commerce

  • Mental Health Counselor
  • McKinney, TX
  • NPI 1497400782
  NPD (past)

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491868800000",
    "number": "1730189960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3011",
            "city": "COMMERCE",
            "state": "TX",
            "postal_code": "754293011",
            "telephone_number": "903-886-5853",
            "fax_number": "903-886-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 W NEAL ST",
            "city": "COMMERCE",
            "state": "TX",
            "postal_code": "754284311",
            "telephone_number": "903-886-5853",
            "fax_number": "903-886-5854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "MAXINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-29",
        "last_updated": "2017-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA00418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179683101",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kellie McBroom, OTR
• McDaniel General Dentistry
• Marc Warren McDaniel, D.D.S.
• Mary Grace McDaniel, D.D.S.
• Latisha Michelle McMurray
• Sarah Marie Mitchell, ATC, LAT
• Victoria Mitchell
• Ravi Morisetty
• Duong T Nguyen, RPH
• Nielsen Dentistry PLLC (Commerce Family Dental)

• Physician Assistant in Commerce, TX
• Providers in Commerce, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; 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.