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General NPI Number Information
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NPI Number | 1942295639
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Entity Type | Individual
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Provider Name | MARIO A MENDIZABAL MD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 921 N CITRUS AVE
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-3422
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Country | US
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Telephone | 352-436-4328
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Fax | 352-260-0960
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Provider Business Mailing Address
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Address Line | 2320 N SUNSHINE PATH
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-5810
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Country | US
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Telephone | 352-795-5888
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Fax | 352-795-6968
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0027030
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License Number State | FL
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