Provider Demographics
NPI:1063011013
Name:MENENDEZ ARCIA, ALDO (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ALDO
Middle Name:
Last Name:MENENDEZ ARCIA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2213
Mailing Address - Country:US
Mailing Address - Phone:954-239-7054
Mailing Address - Fax:786-464-5125
Practice Address - Street 1:6109 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33023-2213
Practice Address - Country:US
Practice Address - Phone:954-239-7054
Practice Address - Fax:786-464-5125
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113834363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program