Provider Demographics
NPI:1073522413
Name:VERONICA R MENDEZ
Entity Type:Organization
Organization Name:VERONICA R MENDEZ
Other - Org Name:MIRACLE HEALTH PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DME PROVIDER
Authorized Official - Phone:210-927-2006
Mailing Address - Street 1:660 S W MILITARY DRIVE
Mailing Address - Street 2:SUITE V
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1686
Mailing Address - Country:US
Mailing Address - Phone:210-927-2006
Mailing Address - Fax:210-927-2051
Practice Address - Street 1:660 SW MILITARY DR
Practice Address - Street 2:SUITE V
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1645
Practice Address - Country:US
Practice Address - Phone:210-927-2006
Practice Address - Fax:210-927-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169698102Medicaid
TX169698102Medicaid