Provider Demographics
NPI:1164477980
Name:MENDOZA, JULIE CARVAJAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:CARVAJAL
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULITA
Other - Middle Name:CARVAJAL
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1300 SAWGRASS CORPORATE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2826
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-858-0404
Practice Address - Street 1:3030 W. DR. MLK JR. BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6308
Practice Address - Country:US
Practice Address - Phone:813-879-4730
Practice Address - Fax:954-858-0404
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010390532080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279968500Medicaid
IN200198930Medicaid
OH0859334Medicaid
MI3495805Medicaid