Healthcare Provider Details

I. General information

NPI: 1043628118
Provider Name (Legal Business Name): CARLOS A MENDEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 40TH ST W
BRADENTON FL
34205-1724
US

IV. Provider business mailing address

802 40TH ST W
BRADENTON FL
34205-1724
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-5885
  • Fax: 941-749-5664
Mailing address:
  • Phone: 941-748-5885
  • Fax: 941-749-5664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME46189
License Number StateFL

VIII. Authorized Official

Name: DR. CARLOS A MENDEZ
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 941-748-5885