Provider Demographics
NPI:1932686003
Name:DR GUILLERMO MENDOZA - INT MED - LLC
Entity Type:Organization
Organization Name:DR GUILLERMO MENDOZA - INT MED - LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:MENDOZA FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-890-9748
Mailing Address - Street 1:2572 W STATE ROAD 426 STE 3040
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8389
Mailing Address - Country:US
Mailing Address - Phone:407-890-9748
Mailing Address - Fax:407-890-9819
Practice Address - Street 1:2572 W STATE ROAD 426 STE 3040
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8389
Practice Address - Country:US
Practice Address - Phone:407-890-9748
Practice Address - Fax:407-890-9819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty