MEDICARE: DR. MARGARITA MERCEDES VENDRELL M.D.

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	207Q00000X	Family Medicine Physician	ME71818	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	:	1851317580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARITA MERCEDES VENDRELL M.D.

Provider Business Mailing Address
First Line	:	12276 SAN JOSE BLVD STE 608
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8672
Country	:	US
Telephone Number	:	904-446-9205
Fax Number	:	904-446-9250

Provider Business Practice Location Address
First Line	:	12276 SAN JOSE BLVD
Second Line	:	STE. 608
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8628
Country	:	US
Telephone Number	:	904-446-9205
Fax Number	:	904-446-9250

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	04/25/2012

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