Healthcare Provider Details

I. General information

NPI: 1770790057
Provider Name (Legal Business Name): IVAN MENDOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: IVAN MENDOZA MD

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BISCAYNE BLVD STE 230
MIAMI FL
33137-9800
US

IV. Provider business mailing address

1500 NW 12TH AVE STE 810
MIAMI FL
33136-1037
US

V. Phone/Fax

Practice location:
  • Phone: 786-466-8490
  • Fax:
Mailing address:
  • Phone: 305-585-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME109272
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: