Provider Demographics
NPI:1073724258
Name:MENDEZ, FREDESWINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDESWINDA
Middle Name:
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 1:200 AVE JESUS T PINERO
Mailing Address - Street 2:APT 18 D
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4109
Mailing Address - Country:US
Mailing Address - Phone:787-764-1494
Mailing Address - Fax:
Practice Address - Street 1:1559 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-2718
Practice Address - Country:US
Practice Address - Phone:787-764-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR58662084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR04124Medicare UPIN