Healthcare Provider Details

I. General information

NPI: 1235261660
Provider Name (Legal Business Name): LUIS FELIPE MENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 03/07/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 W VINE ST
KISSIMMEE FL
34741-3738
US

IV. Provider business mailing address

3185 W VINE ST
KISSIMMEE FL
34741-3738
US

V. Phone/Fax

Practice location:
  • Phone: 407-569-1260
  • Fax: 833-963-0109
Mailing address:
  • Phone: 407-569-1260
  • Fax: 833-963-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15994
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN607
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: