Healthcare Provider Details

I. General information

NPI: 1255343398
Provider Name (Legal Business Name): HERIBERTO MENENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 JEMIMA AVE
THE VILLAGES FL
32163-2329
US

IV. Provider business mailing address

3133 JEMIMA AVE
THE VILLAGES FL
32163-2329
US

V. Phone/Fax

Practice location:
  • Phone: 352-203-4935
  • Fax:
Mailing address:
  • Phone: 352-203-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35092986
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: