Healthcare Provider Details

I. General information

NPI: 1720804263
Provider Name (Legal Business Name): MENDOZA MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14324 SW 264TH ST UNIT 400
HOMESTEAD FL
33032-7446
US

IV. Provider business mailing address

14324 SW 264TH ST UNIT 400
HOMESTEAD FL
33032-7446
US

V. Phone/Fax

Practice location:
  • Phone: 305-562-9824
  • Fax:
Mailing address:
  • Phone: 786-650-2843
  • Fax: 786-650-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YUSLEIDYS L VELAZQUEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-562-9824