Healthcare Provider Details

I. General information

NPI: 1497021331
Provider Name (Legal Business Name): VANESSA MENDEZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W 68TH ST STE 300
HIALEAH FL
33016
US

IV. Provider business mailing address

2140 W 68TH ST STE 300
HIALEAH FL
33016-1815
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-4107
  • Fax: 786-497-2989
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME131601
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01084997A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: