Provider Demographics
NPI:1770310120
Name:ALFONSO MENDOZA, ROSALBA
Entity type:Individual
Prefix:
First Name:ROSALBA
Middle Name:
Last Name:ALFONSO MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 PANKAW LN
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6515
Mailing Address - Country:US
Mailing Address - Phone:813-650-6597
Mailing Address - Fax:
Practice Address - Street 1:2747 PANKAW LN
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6515
Practice Address - Country:US
Practice Address - Phone:813-650-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035093363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care