Provider Demographics
NPI:1669483517
Name:MENENDEZ, JULIAN ROBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:ROBERT
Last Name:MENENDEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 PARK ST N STE C
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1028
Mailing Address - Country:US
Mailing Address - Phone:727-544-5425
Mailing Address - Fax:
Practice Address - Street 1:5415 PARK ST N STE C
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1028
Practice Address - Country:US
Practice Address - Phone:727-544-5425
Practice Address - Fax:727-544-5440
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3257163WW0000X, 213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV11282Medicare UPIN