MEDICARE: ALDO MENENDEZ ARCIA PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9113834	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1063011013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALDO MENENDEZ ARCIA PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	6109 PEMBROKE RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-2213
Country	:	US
Telephone Number	:	954-239-7054
Fax Number	:	786-464-5125

Provider Business Practice Location Address
First Line	:	6109 PEMBROKE RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-2213
Country	:	US
Telephone Number	:	954-239-7054
Fax Number	:	786-464-5125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	07/26/2021

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