1055 N. LA CANADA BLVD SUITE 121
GREEN VALLEY, AZ 85614 US PECOS Enrolled
Edita Extra-Mendoza
Internal Medicine Physician
- GREEN VALLEY, AZ
- Phone: (520)-547-7770
- Last Updated 4/20/2017
Overview
Edita Extra-Mendoza is a Internal Medicine Physician in the GREEN VALLEY area and has over 36 years of experience. Edita Extra-Mendoza primary office location is at 1055 N. LA CANADA BLVD and new patients are welcome to contact this healthcare provider for an appointment. We do not know where she was educated but we know that she graduated in 1988
Edita Extra-Mendoza is affiliated with five hospitals in the GREEN VALLEY area, including . The NPI number is 1326023839 and the information was updated approximately 7 years ago.
Edita Extra-Mendoza is affiliated with one medical group in the GREEN VALLEY area, ARIZONA COMMUNITY PHYSICIANS PC.
We have not detected any Exclusions tied directly to this NPI.
Accepts Medicare Assignment: Unknown
Is sole proprietor: NO
Participates in PECOS: YES (See any PECOS details below)
Contact Information
| License Number | State |
|---|---|
| 24412 | AZ |
| Type/Issuer | Identifier | State |
|---|---|---|
| MEDICAID | 449787 | AZ |
| MEDICARE PTAN | Z145043 | AZ |
| Taxonomy | State | Primary? |
|---|---|---|
| Internal Medicine Physician - Taxonomy Code 207R00000X | AZ | Y |
PECOS Details:
| Participates in PECOS: | YES |
| PECOS Individual Enrollment ID: | I20050621000707 |
| PECOS Individual PAC ID: | 5496790420 |
| Eligible to order/refer Part B Clinical Laboratory and Imaging | Yes |
| Eligible to order/refer Durable Medical Equipment (DME) | Yes |
| Eligible to order/refer Home Health Agency (HHA) | Yes |
| Eligible to order/refer Power Mobility Devices (PMD) | Yes |
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