Provider Demographics
NPI:1740466226
Name:JESUS B. MENENDEZ-RIVERA MD PA
Entity type:Organization
Organization Name:JESUS B. MENENDEZ-RIVERA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:B
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-337-2727
Mailing Address - Street 1:7290 SW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3121
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84372174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4637OtherMEDICARE
FL262153300Medicaid