Provider Demographics
NPI:1033597125
Name:MENDEZ, ANA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
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 1:109 STATE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-2906
Mailing Address - Country:US
Mailing Address - Phone:617-505-1520
Mailing Address - Fax:617-928-8401
Practice Address - Street 1:109 STATE ST STE 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-2906
Practice Address - Country:US
Practice Address - Phone:617-505-1520
Practice Address - Fax:617-928-8401
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8880207Q00000X
AZ56577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty