Provider Demographics
NPI:1568285591
Name:PUEBLA MENDOZA, DENIS I (LMT)
Entity type:Individual
Prefix:MR
First Name:DENIS
Middle Name:
Last Name:PUEBLA MENDOZA
Suffix:I
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 BAYSHORE BLVD BLDG UNIT406
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7353
Mailing Address - Country:US
Mailing Address - Phone:786-609-4584
Mailing Address - Fax:
Practice Address - Street 1:2611 BAYSHORE BLVD APT 405
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7358
Practice Address - Country:US
Practice Address - Phone:786-609-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA106160225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist