Individual
DR. LENNY TUA MENDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4725 US HIGHWAY 98 S STE 102, LAKELAND, FL 33812-4334
(863) 646-9191
(863) 646-5252
Mailing address
6675 WESTWOOD BLVD STE 475, ORLANDO, FL 32821-6027
(078) 450-3304
(889) 721-7528
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
16894
PR
208D00000X
General Practice Physician
Primary
ACN532
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012863800
—
FL
01
—
1119187
CAREPLUS
FL
01
—
1456278
WELLCARE
—
01
—
FG350A
MEDICARE
FL
01
—
P01756119
SIMPLY
FL
01
—
P1056619
FREEDOM
FL
01
—
P988170
OPTIMUM
FL
Enumeration date
10/17/2007
Last updated
03/27/2018
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