Nelia Mendoza San Jose-Carlson, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

0101245684 Issued in VA

Practice address

420 Hudgins Rd
Suite 204
Fredericksburg, VA 22408-4172

Phone

(814) 591-8455

NPI assigned

Jun 29, 2006

Last updated

Apr 14, 2010By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Nelia Mendoza San Jose Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Colonial Behavioral Health

  • Health Maintenance Organization
  • Williamsburg, VA
  • NPI 1841556776
  NPD (past)

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271203200000",
    "number": "1831127992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 HAMS CT",
            "city": "WOODFORD",
            "state": "VA",
            "postal_code": "225809646",
            "telephone_number": "814-591-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 HUDGINS RD",
            "address_2": "SUITE 204",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224084172",
            "telephone_number": "814-591-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAN JOSE-CARLSON",
        "first_name": "NELIA",
        "middle_name": "MENDOZA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2010-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101245684",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MDO67980L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BC/BS",
            "identifier": "008450693",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017557270002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH PROVIDER #",
            "identifier": "5624399",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NELIA",
            "last_name": "SAN JOSE",
            "middle_name": "MENDOZA",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christy Salisbury, LMT
• Paulino D Sambat Jr., MD
• Mitzi Jean Sampson, M.D.
• Etsub Samuel, MD
• Pariss Samuels
• Noel Annette Sanders-Williams, APRN
• Brittani B Sanders, LCSW
• Julie Elizabeth Sanders, OTR/L
• Monique Sanders, LPTA
• Rene Gennette Sanders, NP

• Psychiatry Physician in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Psychiatry Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2010; 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.