Provider Demographics
NPI:1609119528
Name:EDUARDO S MENDEZ MD PA
Entity Type:Organization
Organization Name:EDUARDO S MENDEZ MD PA
Other - Org Name:EDUARDO S MENDEZ MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-953-6415
Mailing Address - Street 1:9600 SW 8TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2900
Mailing Address - Country:US
Mailing Address - Phone:786-953-6415
Mailing Address - Fax:
Practice Address - Street 1:9600 SW 8TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2900
Practice Address - Country:US
Practice Address - Phone:786-953-6415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83615261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center