MEDICARE: JUAN 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	106H00000X	Marriage & Family Therapist	MT3868	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	:	1801484860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN MENDEZ

Provider Business Mailing Address
First Line	:	5714 KEATON SPRINGS DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-1884
Country	:	US
Telephone Number	:	863-546-1183
Fax Number	:

Provider Business Practice Location Address
First Line	:	5714 KEATON SPRINGS DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33811-1884
Country	:	US
Telephone Number	:	863-546-1183
Fax Number	:

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

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	06/05/2023

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Directions to “ JUAN MENDEZ ” Practice Location

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