Provider Demographics
NPI:1235261660
Name:MENDEZ, LUIS FELIPE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FELIPE
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 1:3185 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3738
Mailing Address - Country:US
Mailing Address - Phone:407-569-1260
Mailing Address - Fax:833-963-0109
Practice Address - Street 1:3185 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3738
Practice Address - Country:US
Practice Address - Phone:407-569-1260
Practice Address - Fax:833-963-0109
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15994208D00000X
FLACN607208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN607OtherMEDICAL LIC
FL116298900Medicaid
FL116298900Medicaid