Provider Demographics
NPI:1770169062
Name:MENDEZ GIORDANO, DIEGO IGNACIO
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:IGNACIO
Last Name:MENDEZ GIORDANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 METROPOLIS WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2706
Mailing Address - Country:US
Mailing Address - Phone:321-344-1273
Mailing Address - Fax:855-540-0677
Practice Address - Street 1:5920 METROPOLIS WAY STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2706
Practice Address - Country:US
Practice Address - Phone:213-341-2733
Practice Address - Fax:855-540-0677
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9114113OtherFLORIDA DEPARTMENT OF HEALTH