Basic Information
| Provider Information | |||||||||
| NPI: | 1205854171 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MENDEZ FAMILY CARE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 WELLS RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | ORANGE PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320732982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042826331 | ||||||||
| FaxNumber: | 9046191080 | ||||||||
| Practice Location | |||||||||
| Address1: | 1909 BEACH BLVD STE 102 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322502643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042462752 | ||||||||
| FaxNumber: | 9042462758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHANDLER | ||||||||
| AuthorizedOfficialFirstName: | ZANDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9042826331 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | DF4853 | 01 | FL | MEDICARE RAILROAD | OTHER | 277539500 | 05 | FL | MEDICAID |