# ANSELMO MANUEL MENDIVE, MD. PA.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619011228
- **Authorized official:** MRS. YIN GARCIA (OFFICE MANAGER)
- **Authorized official phone:** (305) 801-7030

## Contact information

- **Practice address:** 4601 NW 199TH ST, SUITE E, MIAMI GARDENS, FL 33055-1508
- **Practice address phone:** (305) 801-7030
- **Practice address fax:** (305) 623-7044
- **Mailing address:** 4601 NW 199TH ST, SUITE E, MIAMI GARDENS, FL 33055-1508
- **Mailing address phone:** (305) 801-7030
- **Mailing address fax:** (305) 623-7044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME56412 | FL | Yes |

## Other

- **Enumeration date:** 02/16/2007
- **Last updated:** 01/31/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 048992100 | — | FL |
| 05 | — | 048992101 | — | FL |