Provider Demographics
NPI:1710343272
Name:MENDOZA, ALEXIS N (CRNA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:N
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3580 NW 85TH CT
Mailing Address - Street 2:APT 561
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1984
Mailing Address - Country:US
Mailing Address - Phone:407-409-2985
Mailing Address - Fax:
Practice Address - Street 1:3580 NW 85TH CT
Practice Address - Street 2:APT 561
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1984
Practice Address - Country:US
Practice Address - Phone:407-409-2985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177107367500000X
FL9283983367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered