Provider Demographics
NPI:1275734014
Name:ANGEL F MENDEZ MD PA
Entity Type:Organization
Organization Name:ANGEL F MENDEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-643-0303
Mailing Address - Street 1:5980 SW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-8126
Mailing Address - Country:US
Mailing Address - Phone:305-669-0871
Mailing Address - Fax:305-669-0031
Practice Address - Street 1:2435 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3134
Practice Address - Country:US
Practice Address - Phone:305-643-0303
Practice Address - Fax:305-643-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2755661-01Medicaid
FL2755661-01Medicaid
FLK9121Medicare ID - Type Unspecified