Provider Demographics
NPI:1932134467
Name:MENDEZ, MANUEL V (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:V
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 1:1620 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6502
Mailing Address - Country:US
Mailing Address - Phone:561-833-0770
Mailing Address - Fax:561-659-4830
Practice Address - Street 1:1620 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6502
Practice Address - Country:US
Practice Address - Phone:561-833-0770
Practice Address - Fax:561-659-4830
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME792342086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258055100Medicaid
FL49297Medicare ID - Type Unspecified
FL258055100Medicaid