Healthcare Provider Details

I. General information

NPI: 1013832468
Provider Name (Legal Business Name): MARIA REBECA ALVARADO MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5761 S US HWY 17 92 SUITES 1001 & 1005, CASSELBERRY, FL
CASSELBERRY FL
32707
US

IV. Provider business mailing address

7768 CLOVE HITCH WAY
ORLANDO FL
32832-3000
US

V. Phone/Fax

Practice location:
  • Phone: 407-670-0557
  • Fax:
Mailing address:
  • Phone: 425-436-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: