Provider Demographics
NPI:1104375153
Name:MENDEZ, KEYLA
Entity Type:Individual
Prefix:
First Name:KEYLA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 AVE DOMENECH
Mailing Address - Street 2:202
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3523
Mailing Address - Country:US
Mailing Address - Phone:787-777-1616
Mailing Address - Fax:
Practice Address - Street 1:207 AVE DOMENECH
Practice Address - Street 2:202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3523
Practice Address - Country:US
Practice Address - Phone:787-777-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR80581-G163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse