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Organization

ANSELMO MANUEL MENDIVE, MD. PA.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. YIN GARCIA (OFFICE MANAGER)
(305) 801-7030
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME56412
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
048992100
FL
05
048992101
FL
Enumeration date
02/16/2007
Last updated
01/31/2012
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