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General NPI Number Information
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NPI Number | 1447300876
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Entity Type | Individual
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Provider Name | NICHOLAS MENTUS MD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 14567 WHITE JADE TER
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2230
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Country | US
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Telephone | 718-344-7863
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Fax | 561-501-7963
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Provider Business Mailing Address
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Address Line | 14567 WHITE JADE TER
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2230
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Country | US
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Telephone | 718-344-7863
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Fax | 561-501-7963
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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 | ME96221
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License Number State | FL
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