Healthcare Provider Details

I. General information

NPI: 1518542422
Provider Name (Legal Business Name): EDGARDO ONEILL ORTIZ-MENDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 S SEMORAN BLVD STE B-C
ORLANDO FL
32807-1457
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-1376
  • Fax: 321-235-3232
Mailing address:
  • Phone: 210-630-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24170
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number16829-1
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: