Provider Demographics
NPI:1871113910
Name:LEAL MENDEZ, MARIO ARTURO (SA-C)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ARTURO
Last Name:LEAL MENDEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 DEER POINT LN
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5716
Mailing Address - Country:US
Mailing Address - Phone:305-219-8931
Mailing Address - Fax:
Practice Address - Street 1:7205 DEER POINT LN
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-5716
Practice Address - Country:US
Practice Address - Phone:305-219-8931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-202246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant