Provider Demographics
NPI:1023007119
Name:MENDIZABAL, ROLANDO CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:CESAR
Last Name:MENDIZABAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1295 NW 14TH ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1610
Mailing Address - Country:US
Mailing Address - Phone:305-325-4541
Mailing Address - Fax:305-324-5327
Practice Address - Street 1:1295 NW 14TH ST
Practice Address - Street 2:SUITE I
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1610
Practice Address - Country:US
Practice Address - Phone:305-325-4541
Practice Address - Fax:305-324-5327
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME26739207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035560700Medicaid
FL592302851OtherCORPORATE TAX ID
FL92564Medicare PIN
FLD60106Medicare UPIN