Provider Demographics
NPI:1689617110
Name:MENENDEZ, ROXANNA MARIA (DO)
Entity Type:Individual
Prefix:DR
First Name:ROXANNA
Middle Name:MARIA
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15051 S. TAMIAMI TRAIL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-437-8810
Mailing Address - Fax:239-313-2555
Practice Address - Street 1:25987 S. TAMIAMI TRAIL
Practice Address - Street 2:UNIT 90
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134
Practice Address - Country:US
Practice Address - Phone:239-444-3201
Practice Address - Fax:239-992-9359
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7812207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257016500Medicaid
FL257016500Medicaid