Provider Demographics
NPI:1518006378
Name:MENDOZA, GEMMA I (MD)
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:I
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:787 37TH ST
Mailing Address - Street 2:SUITE E-210
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7305
Mailing Address - Country:US
Mailing Address - Phone:772-562-5232
Mailing Address - Fax:772-562-0773
Practice Address - Street 1:787 37TH ST
Practice Address - Street 2:SUITE E-210
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7305
Practice Address - Country:US
Practice Address - Phone:772-562-5232
Practice Address - Fax:772-562-0773
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL00258112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85601Medicare UPIN