Provider Demographics
NPI:1073630828
Name:LUCIANO- MENDEZ, MARIA (RPT)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:
Last Name:LUCIANO- MENDEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 9928
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-9714
Mailing Address - Country:US
Mailing Address - Phone:787-597-3250
Mailing Address - Fax:
Practice Address - Street 1:CARR 447 KM 4.5 INT
Practice Address - Street 2:BO ROBLES SECTOR PARAISO
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-597-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist