Provider Demographics
NPI:1548847304
Name:MENENDEZ & FAMILY CORP
Entity type:Organization
Organization Name:MENENDEZ & FAMILY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-332-8801
Mailing Address - Street 1:2172 NE 123RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2902
Mailing Address - Country:US
Mailing Address - Phone:786-542-5140
Mailing Address - Fax:
Practice Address - Street 1:2172 NE 123RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2902
Practice Address - Country:US
Practice Address - Phone:786-542-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLICENSEOtherME124889