Provider Demographics
NPI:1639186018
Name:ROIS-MENDEZ, ALIDA (CRNA)
Entity Type:Individual
Prefix:
First Name:ALIDA
Middle Name:
Last Name:ROIS-MENDEZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ALIDA
Other - Middle Name:
Other - Last Name:ROIS-MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 817737
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33081-1737
Mailing Address - Country:US
Mailing Address - Phone:954-838-2588
Mailing Address - Fax:954-851-1758
Practice Address - Street 1:1613 N HARRISON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323
Practice Address - Country:US
Practice Address - Phone:954-838-2371
Practice Address - Fax:954-851-1758
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9214779367500000X
FLARNP 9214779367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306432800Medicaid
FL$$$$$$$$$OtherCHAMPUS