Marielle Corazon Bantog Mendoza, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

W8594 Issued in TX

Practice address

3615 19TH St
Lubbock, TX 79410-1203

Phone

(806) 725-0000

NPI assigned

Apr 17, 2023

Last updated

Sep 28, 2026By 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 names 1

• Marielle Corazon Fune Bantog Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790553600000",
    "number": "1801582473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3615 19TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101203",
            "telephone_number": "806-725-0000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3615 19TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101203",
            "telephone_number": "806-725-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "MARIELLE CORAZON",
        "middle_name": "BANTOG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-17",
        "last_updated": "2026-09-28",
        "certification_date": "2026-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "W8594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIELLE CORAZON",
            "last_name": "BANTOG",
            "middle_name": "FUNE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heather Menasco, LCSW
• Hailey Rae Mendez
• Mary Ellen Mendez, LVN
• Michael Perez Mendez, M.D.
• Elisa Mendoza
• Martina Mendoza, APRN, FNP-BC
• Miranda Ivy Mendoza
• Nancy Mendoza
• Reagan Naomi Mendoza
• Chris Alan Menegay, LPC

• Internal Medicine Physician in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2026; 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.