Healthcare Provider Details

I. General information

NPI: 1245770601
Provider Name (Legal Business Name): LUIS ALBERTO MENDOZA MORET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9299 CORAL REEF DR STE 203
PALMETTO BAY FL
33157-1776
US

IV. Provider business mailing address

9299 CORAL REEF DR STE 203
PALMETTO BAY FL
33157-1776
US

V. Phone/Fax

Practice location:
  • Phone: 305-234-9180
  • Fax: 305-234-9182
Mailing address:
  • Phone: 305-234-9180
  • Fax: 305-234-9182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME176411
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME176411
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTRN27471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: