Healthcare Provider Details

I. General information

NPI: 1699078972
Provider Name (Legal Business Name): LUCAS MIGUEL MENDOZA MD (HOUSE PHYSICIAN)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 07/16/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JACKSON SOUTH MEDICAL CENTER 9333 W 152 ST
MIAMI FL
33157
US

IV. Provider business mailing address

10317 W 33 LN
HIALEAH FL
33018
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-2500
  • Fax: 305-256-2213
Mailing address:
  • Phone: 786-338-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberHSE281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: