Provider Demographics
NPI:1013978816
Name:MENENDEZ RIVERA, JESUS B (MD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:B
Last Name:MENENDEZ RIVERA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2267 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1512
Mailing Address - Country:US
Mailing Address - Phone:305-337-2727
Mailing Address - Fax:305-337-2728
Practice Address - Street 1:2267 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1512
Practice Address - Country:US
Practice Address - Phone:305-337-2727
Practice Address - Fax:305-337-2728
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84372208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262153300Medicaid
FLH28358Medicare UPIN
FLE4637Medicare ID - Type Unspecified