1699078972 NPI number — LUCAS MIGUEL MENDOZA MD (HOUSE PHYSICIAN)

Table of content: LUCAS MIGUEL MENDOZA MD (HOUSE PHYSICIAN) (NPI 1699078972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699078972 NPI number — LUCAS MIGUEL MENDOZA MD (HOUSE PHYSICIAN)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDOZA
Provider First Name:
LUCAS
Provider Middle Name:
MIGUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD (HOUSE PHYSICIAN)
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699078972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10317 W 33 LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-338-3828
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JACKSON SOUTH MEDICAL CENTER
Provider Second Line Business Practice Location Address:
9333 W 152 ST
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-251-2500
Provider Business Practice Location Address Fax Number:
305-256-2213
Provider Enumeration Date:
12/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  HSE281 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 701 . This is a "NATIONAL SURGICAL ASSISTANTS ASSOCIATION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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