Basic Information
| Provider Information | |||||||||
| NPI: | 1275599953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | CESAR | ||||||||
| MiddleName: | EMILIO | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 NW 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864668456 | ||||||||
| FaxNumber: | 3055736562 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 NW 9TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864668456 | ||||||||
| FaxNumber: | 3055736562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 05/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | ME88251 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 090480 | 05 | AZ | MEDICAID | 0054760-00 | 05 | FL | MEDICAID | GD175Z | 01 | FL | MEDICARE | OTHER |