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General NPI Number Information
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NPI Number | 1114985199
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Entity Type | Individual
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Provider Name | CONSTANTINO GILBERTO MENDIETA MD
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2310 S DIXIE HWY
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City | MIAMI
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State | FL
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Zip | 33133-2314
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Country | US
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Telephone | 305-860-0717
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Fax | 305-858-6570
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Provider Business Mailing Address
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Address Line | 3637 ROYAL PALM AVE
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City | MIAMI
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State | FL
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Zip | 33133-6226
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Country | US
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Telephone | 305-860-0717
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Fax | 305-858-6570
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 070055
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License Number State | FL
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