MEDICARE: MO HEALTH GROUP, LLC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1205567674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MO HEALTH GROUP, LLC

Provider Business Mailing Address
First Line	:	2122 SW 67TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1838
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 SW 67TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1838
Country	:	US
Telephone Number	:	786-295-0479
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARIO RUBEN MENDEZ
Credential	:
Telephone Number	:	786-295-0479

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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Directions to “MO HEALTH GROUP, LLC ” Practice Location

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