Provider Demographics
NPI:1699078972
Name:MENDOZA, LUCAS MIGUEL (MD (HOUSE PHYSICIAN))
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:MIGUEL
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD (HOUSE PHYSICIAN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 W 33 LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:786-338-3828
Mailing Address - Fax:
Practice Address - Street 1:JACKSON SOUTH MEDICAL CENTER
Practice Address - Street 2:9333 W 152 ST
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-251-2500
Practice Address - Fax:305-256-2213
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE281208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC701OtherNATIONAL SURGICAL ASSISTANTS ASSOCIATION