Individual provider Active NPI

Christian Mendoza, PA-C

  • Physician Assistant
  • Brandon, FL
National Provider Identifier
1912784562
Registry record updated Apr 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9117793 Issued in FL
Practice address
109 Margaret St
Brandon, FL 33511-5203
Phone
(813) 654-2544
Fax
(813) 653-4391
NPI assigned
Sep 8, 2023
Last updated
Apr 23, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9117793 FL Primary

Addresses

Primary practice location

109 Margaret St
Brandon, FL 33511-5203

Mailing address

109 Margaret St
Brandon, FL 33511-5203
Phone (813) 654-2544

Other practice location 1

4164 N Armenia Ave
Tampa, FL 33607-6429
Phone (813) 879-7546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250429002287 FL Practitioner - Physician Assistant 0749706166 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Francis a Caban MD PAGroup PAC ID 6103914742, 4 clinicians

Practice addresses (Care Compare)

109 Margaret St
Brandon, FL 33511-5203
Phone (813) 654-2544

4164 N Armenia Ave
Tampa, FL 33607-6429
Phone (813) 879-7546

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medi Prime Care LLC CurrentSince Apr 27, 2025 Accepting new patients

Locations

109 Margaret St
Brandon, FL 33511
Phone (813) 235-4090

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745366400000",
    "number": "1912784562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 MARGARET ST",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115203",
            "telephone_number": "813-654-2544",
            "fax_number": "813-653-4391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 MARGARET ST",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335115203",
            "telephone_number": "813-654-2544",
            "fax_number": "813-653-4391"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4164 N Armenia Ave",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336076429",
            "country_code": "US",
            "telephone_number": "813-879-7546",
            "fax_number": "813-817-6842",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "CHRISTIAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-08",
        "last_updated": "2025-04-23",
        "certification_date": "2025-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9117793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.