Provider Demographics
NPI:1679694541
Name:MENDEZ, SAMUEL (PA C)
Entity Type:Individual
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First Name:SAMUEL
Middle Name:
Last Name:MENDEZ
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Gender:M
Credentials:PA C
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Mailing Address - Street 1:2815 S SEACREST BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7969
Mailing Address - Country:US
Mailing Address - Phone:561-241-1971
Mailing Address - Fax:561-241-3969
Practice Address - Street 1:1900 GLADES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7378
Practice Address - Country:US
Practice Address - Phone:561-416-1145
Practice Address - Fax:561-416-2292
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2018-04-05
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102845363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant