Provider Demographics
NPI:1194408278
Name:MENENDEZ RIZO, JESUS
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:MENENDEZ RIZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 NW 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-7957
Mailing Address - Country:US
Mailing Address - Phone:786-794-6694
Mailing Address - Fax:
Practice Address - Street 1:1751 NW 44TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-7957
Practice Address - Country:US
Practice Address - Phone:786-794-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-491363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical