Provider Demographics
NPI:1225046030
Name:MENDEZ, CARLA M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:M
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:A3 CALLE FRANCIA
Mailing Address - Street 2:GARDEN COURT
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2014
Mailing Address - Country:US
Mailing Address - Phone:787-706-7540
Mailing Address - Fax:787-751-2331
Practice Address - Street 1:405 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3014
Practice Address - Country:US
Practice Address - Phone:787-753-9515
Practice Address - Fax:787-751-2331
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR153362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0022613Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER