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General NPI Number Information
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NPI Number | 1215914148
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Entity Type | Organization
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Legal Business Name | QUERUBIN P MENDOZA MD PA
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 5101 N HABANA AVE
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City | TAMPA
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State | FL
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Zip | 33614-6818
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Country | US
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Telephone | 813-248-2700
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Fax | 813-248-2722
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Provider Business Mailing Address
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Address Line | 5101 N HABANA AVE
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City | TAMPA
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State | FL
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Zip | 33614-6818
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Country | US
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Telephone | 813-248-2700
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Fax | 813-248-2722
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. QUERUBIN MENDOZA
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Credential | MD
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Telephone | 813-248-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | ME74240
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME74240
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License Number State | FL
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