Healthcare Provider Details

I. General information

NPI: 1417542291
Provider Name (Legal Business Name): DILTO AARON MENDOZA BELLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 07/03/2025
Certification Date: 06/03/2025
Deactivation Date: 04/06/2022
Reactivation Date: 07/19/2022

III. Provider practice location address

CORNER OF ROUTE N12 AND N7
FORT DEFIANCE AZ
86504-0649
US

IV. Provider business mailing address

2715 SW 115TH AVE
MIAMI FL
33165-2128
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8000
  • Fax:
Mailing address:
  • Phone: 786-326-6586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME169825
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: