Provider Demographics
NPI:1568580983
Name:ROLANDO C MENDIZABAL MD PA
Entity Type:Organization
Organization Name:ROLANDO C MENDIZABAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:CESAR
Authorized Official - Last Name:MENDIZABAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-325-4541
Mailing Address - Street 1:1295 NW 14TH ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1610
Mailing Address - Country:US
Mailing Address - Phone:305-325-4541
Mailing Address - Fax:305-324-5327
Practice Address - Street 1:1295 NW 14TH ST
Practice Address - Street 2:SUITE I
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1610
Practice Address - Country:US
Practice Address - Phone:305-325-4541
Practice Address - Fax:305-324-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26739174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035560700Medicaid
FL92564Medicare ID - Type Unspecified
FL035560700Medicaid