Provider Demographics
NPI:1679503452
Name:MENDEZ, ALBERTO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:A
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4420
Mailing Address - Country:US
Mailing Address - Phone:407-962-4447
Mailing Address - Fax:407-962-4449
Practice Address - Street 1:204 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4420
Practice Address - Country:US
Practice Address - Phone:407-962-4447
Practice Address - Fax:407-962-4449
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81717174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH40670Medicare UPIN
FL58538Medicare ID - Type Unspecified