Provider Demographics
NPI:1417542291
Name:MENDOZA, DILTO AARON
Entity Type:Individual
Prefix:
First Name:DILTO
Middle Name:AARON
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12942 SW 208TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-5539
Mailing Address - Country:US
Mailing Address - Phone:786-326-6586
Mailing Address - Fax:
Practice Address - Street 1:4215 SW 72ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4510
Practice Address - Country:US
Practice Address - Phone:305-377-3297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2022-07-19
Deactivation Date:2022-04-06
Deactivation Code:
Reactivation Date:2022-07-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program