Provider Demographics
NPI:1316012495
Name:MENDOZA ORTIZ, JUAN A SR (MD)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:A
Last Name:MENDOZA ORTIZ
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5430
Mailing Address - Street 2:
Mailing Address - City:CAGUES
Mailing Address - State:PR
Mailing Address - Zip Code:00726-5430
Mailing Address - Country:US
Mailing Address - Phone:787-743-7153
Mailing Address - Fax:787-743-7153
Practice Address - Street 1:OFICINA 203 EDIFICIO PROFESIONAL
Practice Address - Street 2:HOSPITAL MENONITA CAYEY
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-263-1010
Practice Address - Fax:787-743-7153
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR29491MEMedicare ID - Type Unspecified
C77696Medicare UPIN