MEDICARE: JOSE ROBERTO MENDOZA 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	207R00000X	Internal Medicine Physician	ME80536	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851349518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE ROBERTO MENDOZA M.D.

Provider Business Mailing Address
First Line	:	2770 CAPITAL MEDICAL BLVD STE 200
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-8419
Country	:	US
Telephone Number	:	850-878-8235
Fax Number	:	850-671-2766

Provider Business Practice Location Address
First Line	:	2770 CAPITAL MEDICAL BLVD STE 200
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-8419
Country	:	US
Telephone Number	:	850-878-8235
Fax Number	:	850-671-2766

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/18/2022

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