Provider Demographics
NPI:1720804263
Name:MENDOZA MEDICAL CENTER CORP
Entity type:Organization
Organization Name:MENDOZA MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUSLEIDYS
Authorized Official - Middle Name:L
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-562-9824
Mailing Address - Street 1:14324 SW 264TH ST UNIT 400
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7446
Mailing Address - Country:US
Mailing Address - Phone:786-650-2843
Mailing Address - Fax:786-650-2796
Practice Address - Street 1:14324 SW 264TH ST UNIT 400
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-7446
Practice Address - Country:US
Practice Address - Phone:305-562-9824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-30
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty