MEDICARE: MR. CHRISTOPHER JOSEPH MENDEZ

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	163W00000X	Registered Nurse	RN60261529	WA
2	367500000X	Certified Registered Nurse Anesthetist	AP61059147	WA

General Provider Information

NPI Number	:	1780205237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER JOSEPH MENDEZ

Provider Business Mailing Address
First Line	:	1451 TREE SWALLOW DR APT 223
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6576
Country	:	US
Telephone Number	:	425-351-3906
Fax Number	:

Provider Business Practice Location Address
First Line	:	1451 TREE SWALLOW DR APT 223
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-6576
Country	:	US
Telephone Number	:	425-351-3906
Fax Number	:

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

Provider Enumeration Date	:	05/06/2020
Last Update Date	:	02/19/2021

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