Provider Demographics
NPI:1376678458
Name:MENDEZ, IDALIA (MD)
Entity Type:Individual
Prefix:
First Name:IDALIA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 SW 143RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6668
Mailing Address - Country:US
Mailing Address - Phone:305-878-1328
Mailing Address - Fax:
Practice Address - Street 1:8420 W FLAGLER ST STE 120
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2045
Practice Address - Country:US
Practice Address - Phone:305-552-0109
Practice Address - Fax:305-559-5300
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine