Healthcare Provider Details

I. General information

NPI: 1497041982
Provider Name (Legal Business Name): JERSON MUNOZ MENDOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3343 SPRINGHILL DR STE 1035
NORTH LITTLE ROCK AR
72117-2930
US

IV. Provider business mailing address

3450 WAYNE AVE 6H
BRONX NY
10467
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-4345
  • Fax:
Mailing address:
  • Phone: 650-483-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN16540
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberE-11286
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: