Healthcare Provider Details

I. General information

NPI: 1891847109
Provider Name (Legal Business Name): MANUEL V MENDEZ M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N DIXIE HWY
WEST PALM BEACH FL
33407-6502
US

IV. Provider business mailing address

1620 N DIXIE HWY
WEST PALM BEACH FL
33407-6502
US

V. Phone/Fax

Practice location:
  • Phone: 561-833-0770
  • Fax: 561-659-4830
Mailing address:
  • Phone: 561-833-0770
  • Fax: 561-659-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME79234
License Number StateFL

VIII. Authorized Official

Name: MANUEL V MENDEZ
Title or Position: OWNER
Credential: M.D.
Phone: 561-833-0770