Healthcare Provider Details

I. General information

NPI: 1811141237
Provider Name (Legal Business Name): MARCOS R MENDEZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1646 N BLUEBIRD LN
HOMESTEAD FL
33035-1010
US

V. Phone/Fax

Practice location:
  • Phone: 305-324-4455
  • Fax:
Mailing address:
  • Phone: 305-766-9629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number81545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: