Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME79894 | FL |
Y | 111NI0900X | Internist | ME79894 | FL |
N | 207RA0401X | Internist - Addiction Medicine | ME79894 | FL |
NPI | 1568462778 |
---|---|
Provider Name | Dr. Joaquin Mendez |
First Address | Pembroke Pines, FL 33026-5207 |
Second Address | Pembroke Pines, FL 33026-5207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 07/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260892800 | (05) | FL |
H13260 | (02) | FL |