Provider Demographics
NPI:1730104795
Name:MENENDEZ, JESUS M (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:M
Last Name:MENENDEZ
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 1:7800 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6523
Mailing Address - Country:US
Mailing Address - Phone:305-267-5253
Mailing Address - Fax:305-267-4412
Practice Address - Street 1:7800 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6523
Practice Address - Country:US
Practice Address - Phone:305-267-5253
Practice Address - Fax:305-267-4412
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59382208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052329100Medicaid
FL052329100Medicaid
FL11780ZMedicare PIN