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General NPI Number Information
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NPI Number | 1225227051
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Entity Type | Individual
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Provider Name | LENNY TUA MENDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 4725 US HIGHWAY 98 S STE 102
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City | LAKELAND
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State | FL
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Zip | 33812-4334
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Country | US
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Telephone | 863-646-9191
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Fax | 863-646-5252
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Provider Business Mailing Address
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Address Line | 6675 WESTWOOD BLVD STE 475
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City | ORLANDO
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State | FL
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Zip | 32821-6027
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Country | US
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Telephone | 78-450-3304
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Fax | 889-721-7528
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 16894
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN532
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License Number State | FL
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