Doctor Name: | GERVASIO R. MENDEZ |
NPI Number: | 1710912589 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ME 24429 |
Business Practice Address: | 17901 Nw 5th St Suite 202 Pembroke Pines, FL - 330292810 |
Business Phone Number: | 9544471994 |
Business Fax Number: | 9544471766 |
Mailing Address: | 8121 Nw 166th St, MIAMI LAKES |
State: | FL |
Postal Code: | 330163499 |
Phone Number: | 3055577970 |
Fax Number: | |
NPI Enumeration Date: | 07/11/2006 |
NPI Last Update Date: | 07/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | ME 24429 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |