Provider Demographics
NPI:1093787475
Name:MENDEZ GARCIA, ILIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ILIANA
Middle Name:
Last Name:MENDEZ GARCIA
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 1:72 CALLE GARDENIA
Mailing Address - Street 2:URBANIZACION CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2206
Mailing Address - Country:US
Mailing Address - Phone:787-750-1843
Mailing Address - Fax:
Practice Address - Street 1:72 CALLE GARDENIA
Practice Address - Street 2:URBANIZACION CIUDAD JARDIN
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-2206
Practice Address - Country:US
Practice Address - Phone:787-750-1843
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16190363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical