Provider Demographics
NPI:1023009552
Name:MENDEZ, ROSARIO N (MD)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:N
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 CALLE CRISANTEMO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6332
Mailing Address - Country:US
Mailing Address - Phone:939-644-9727
Mailing Address - Fax:
Practice Address - Street 1:8 CALLE FLOR GERENA S
Practice Address - Street 2:SUITE 205
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3943
Practice Address - Country:US
Practice Address - Phone:787-641-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11,745174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41297Medicare UPIN