Provider Demographics
NPI:1225227051
Name:MENDEZ, LENNY TUA (MD)
Entity Type:Individual
Prefix:DR
First Name:LENNY
Middle Name:TUA
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:078-450-3304
Mailing Address - Fax:889-721-7528
Practice Address - Street 1:4725 US HIGHWAY 98 S STE 102
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4334
Practice Address - Country:US
Practice Address - Phone:863-646-9191
Practice Address - Fax:863-646-5252
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16894208D00000X
FLACN532208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFG350AOtherMEDICARE
FL012863800Medicaid
1456278OtherWELLCARE
FLP1056619OtherFREEDOM
FLP988170OtherOPTIMUM
FL1119187OtherCAREPLUS
FLP01756119OtherSIMPLY