Provider Demographics
NPI:1447594239
Name:MENDOZA, EFRAIN J (PA)
Entity Type:Individual
Prefix:MR
First Name:EFRAIN
Middle Name:J
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:DR
Other - First Name:EFRAIN
Other - Middle Name:J
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10061 NW 129TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1653
Mailing Address - Country:US
Mailing Address - Phone:561-718-6236
Mailing Address - Fax:305-823-3722
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100123363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical