MEDICARE: MEZEDA MEZE SAINVIL

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	207P00000X	Emergency Medicine Physician	OS11109	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144514332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEZEDA MEZE SAINVIL

Provider Business Mailing Address
First Line	:	3501 NW 38TH AVE
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-5335
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 NW 38TH AVE
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33309-5335
Country	:	US
Telephone Number	:	561-703-2828
Fax Number	:

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

Provider Enumeration Date	:	06/05/2011
Last Update Date	:	08/23/2021

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