Provider Demographics
NPI:1790742922
Name:MENDEZ, ANGEL F (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:F
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 1:5980 SW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-8126
Mailing Address - Country:US
Mailing Address - Phone:305-643-0303
Mailing Address - Fax:
Practice Address - Street 1:2435 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3134
Practice Address - Country:US
Practice Address - Phone:305-643-0303
Practice Address - Fax:305-643-6655
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2755661-01Medicaid
FLE66902Medicare UPIN
FL2755661-01Medicaid