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General NPI Number Information
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NPI Number | 1043628118
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Entity Type | Organization
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Legal Business Name | CARLOS A MENDEZ MD PA
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Dates
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Enumeration Date | 08/01/2014
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Last Update Date | 08/01/2014
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Provider Practice Location Address
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Address Line | 802 40TH ST W
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City | BRADENTON
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State | FL
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Zip | 34205-1724
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Country | US
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Telephone | 941-748-5885
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Fax | 941-749-5664
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Provider Business Mailing Address
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Address Line | 802 40TH ST W
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City | BRADENTON
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State | FL
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Zip | 34205-1724
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Country | US
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Telephone | 941-748-5885
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Fax | 941-749-5664
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CARLOS A MENDEZ
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Credential | M.D.
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Telephone | 941-748-5885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME46189
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License Number State | FL
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