Provider Demographics
NPI:1023741444
Name:MENDEZ LUACES, LUIS E (APRN)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:MENDEZ LUACES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:E
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:330 SW 27TH AVE STE 701
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2968
Mailing Address - Country:US
Mailing Address - Phone:305-363-1880
Mailing Address - Fax:
Practice Address - Street 1:330 SW 27TH AVE STE 701
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2968
Practice Address - Country:US
Practice Address - Phone:305-363-1880
Practice Address - Fax:786-590-1629
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020419363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily