Provider Demographics
NPI:1396725727
Name:DIAZ MENDEZ, HARRY (MD)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:
Last Name:DIAZ MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:HARRY
Other - Middle Name:J
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1344 S APOLLO BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3185
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:6100 MINTON RD NW STE 104
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1900
Practice Address - Country:US
Practice Address - Phone:321-724-1172
Practice Address - Fax:321-984-1695
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124433207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIF714ZOtherMEDICARE
FL120528400Medicaid
150QQOtherBCBS