Individual
GUILLERMO ALFREDO MENDOZA FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2572 W STATE ROAD 426 STE 3040, OVIEDO, FL 32765-8389
(407) 890-9748
(407) 890-9819
Mailing address
2572 W STATE ROAD 426 STE 3040, OVIEDO, FL 32765-8389
(407) 890-9748
(407) 890-9819
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD12761
RI
207R00000X
Internal Medicine Physician
ME117112
FL
208D00000X
General Practice Physician
Primary
ME117112
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009890300
—
FL
01
—
ME117112
MEDICAL LICENSE
FL
Enumeration date
07/18/2008
Last updated
03/07/2023
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