Provider Demographics
NPI:1124415245
Name:MENDEZ, ROSA IVELISSE
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:IVELISSE
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 1:1320 AVE SAN ALFONSO
Mailing Address - Street 2:URB SANTIAGO IGLESIAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3621
Mailing Address - Country:US
Mailing Address - Phone:787-782-6403
Mailing Address - Fax:
Practice Address - Street 1:1320 AVE SAN ALFONSO
Practice Address - Street 2:URB SANTIAGO IGLESIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3621
Practice Address - Country:US
Practice Address - Phone:787-782-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10135183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician