=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376678458
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IDALIA MENDEZ MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 06/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2150 W 76TH ST STE 110
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-1884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-821-9791
-----------------------------------------------------
Fax | 305-827-6783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3105 SW 143RD CT
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-6668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-878-1328
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME97954
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------