| Organization Name: | JOHN V MENDOLA M D |
| NPI Number: | 1174951198 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN VINCENT MENDOLA (MD) |
| Mailing Address: | 10 Beth Stacey Blvd Unit 104 Lehigh Acres |
| State: | FL US |
| Postal Code: | 339366047 |
| Phone Number: | 2017093586 |
| Fax Number: | |
| NPI Enumeration Date: | 10/30/2013 |
| NPI Last Update Date: | 10/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | ME 117536 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |