Provider Demographics
NPI:1164414686
Name:MENDEZ, ALICIA (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
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 1:66 CALLE SANTA CRUZ
Mailing Address - Street 2:INSTITUTO SAN PABLO SUITE 304
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7041
Mailing Address - Country:US
Mailing Address - Phone:787-740-3230
Mailing Address - Fax:787-740-7961
Practice Address - Street 1:CARR 14
Practice Address - Street 2:EDIFICIO PROFESIONAL MENONITA SUITE 207
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4105
Practice Address - Country:US
Practice Address - Phone:787-263-0411
Practice Address - Fax:787-263-0970
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR9428207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E73865Medicare UPIN
PR82143Medicare ID - Type Unspecified