Provider Demographics
NPI:1073701074
Name:COMPLETE CARE CENTER OF MIAMI INC
Entity Type:Organization
Organization Name:COMPLETE CARE CENTER OF MIAMI INC
Other - Org Name:LIZBETH MENDOZA MD,PA,FAAP
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA,FAAFP
Authorized Official - Phone:305-446-1743
Mailing Address - Street 1:1301 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3324
Mailing Address - Country:US
Mailing Address - Phone:305-443-1743
Mailing Address - Fax:
Practice Address - Street 1:1301 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3324
Practice Address - Country:US
Practice Address - Phone:305-443-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0080663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1812AOtherINDIVIDUAL MEDICARE UPIN
FL268210900Medicaid
FL268210900Medicaid