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NPI Code Detail

MEDICARE: DR. MA. CONCEPCION MENDOZA PRUDENCIO MD

MEDICARE: DR. MA. CONCEPCION MENDOZA PRUDENCIO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianME68745FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700847001
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MA. CONCEPCION MENDOZA PRUDENCIO MD
Provider Business Mailing Address
First Line : PO BOX 44008
Second Line : UFJP
City : JACKSONVILLE
State : FL
Zip : 32231-4008
Country : US
Telephone Number : 904-244-3500
Fax Number :
Provider Business Practice Location Address
First Line : 910 N JEFFERSON ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32209-6810
Country : US
Telephone Number : 904-359-3842
Fax Number : 904-359-3847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2006
Last Update Date : 08/29/2007

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