Provider Demographics
NPI:1912195017
Name:MENDEZ, JOSE YSRAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:YSRAEL
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 COMMODITY CIR
Mailing Address - Street 2:SUITE 12
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9071
Mailing Address - Country:US
Mailing Address - Phone:407-476-1212
Mailing Address - Fax:407-476-1213
Practice Address - Street 1:8615 COMMODITY CIR
Practice Address - Street 2:SUITE 12
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9071
Practice Address - Country:US
Practice Address - Phone:407-476-1212
Practice Address - Fax:407-476-1213
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107982207Q00000X, 207R00000X, 2084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005210100Medicaid