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Contact Information

EDITA EXTRA MENDOZA, MD
1055 N. LA CANADA BLVD
SUITE 121
GREEN VALLEY, AZ85614
 Phone: 520-547-7770
 Fax: 520-547-7775
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for EDITA EXTRA MENDOZA · (Female)

NPI # 1326023839
Status Active
Credentials MD
Entity Individual
Enumeration date 12/08/2005
Last updated 04/20/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • AZ License # 24412
  • AZ Medicaid 449787
  • AZ Other Z145043 MEDICARE PTAN
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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