Provider Demographics
NPI:1841528700
Name:AMOS R MENENDEZ MDPA
Entity type:Organization
Organization Name:AMOS R MENENDEZ MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:AMOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-541-3881
Mailing Address - Street 1:711 NW 23RD AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3395
Mailing Address - Country:US
Mailing Address - Phone:305-541-3881
Mailing Address - Fax:305-642-9534
Practice Address - Street 1:711 NW 23RD AVE STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3395
Practice Address - Country:US
Practice Address - Phone:305-541-3881
Practice Address - Fax:305-642-9534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033341208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL208D00000XOtherTAXONOMY CODE
FL95038AMedicare PIN