Healthcare Provider Details

I. General information

NPI: 1649273871
Provider Name (Legal Business Name): ALFREDO MENDOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11912 SHELDON RD
TAMPA FL
33626-3643
US

IV. Provider business mailing address

3001 EXECUTIVE DR STE 130
CLEARWATER FL
33762-5323
US

V. Phone/Fax

Practice location:
  • Phone: 813-920-8882
  • Fax: 813-920-8883
Mailing address:
  • Phone: 727-347-0005
  • Fax: 813-541-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME0092231
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberME92231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: