Healthcare Provider Details

I. General information

NPI: 1407942154
Provider Name (Legal Business Name): MR. EDGAR MENFUG MOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 W 20TH AVE STE 404
HIALEAH FL
33016-1811
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-1417
  • Fax: 305-558-7187
Mailing address:
  • Phone: 305-558-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number3110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: