Healthcare Provider Details

I. General information

NPI: 1124606249
Provider Name (Legal Business Name): PHILIP ANTONIO CLEMENTE MESQUITA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2197
US

IV. Provider business mailing address

8370 W FLAGLER ST STE 226
MIAMI FL
33144-2040
US

V. Phone/Fax

Practice location:
  • Phone: 305-928-7249
  • Fax: 305-630-3632
Mailing address:
  • Phone: 305-928-7249
  • Fax: 305-630-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME170942
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN33226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: