Healthcare Provider Details

I. General information

NPI: 1740210632
Provider Name (Legal Business Name): LUIS MENDEZ-MULET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9240 SW 72ND ST STE 241
MIAMI FL
33173-3265
US

IV. Provider business mailing address

PO BOX 561023
MIAMI FL
33256-1023
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-1905
  • Fax: 305-271-1911
Mailing address:
  • Phone: 305-271-1919
  • Fax: 305-271-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME0083610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: