Provider Demographics
NPI:1326244674
Name:MENDEZ RUIZ, CRISTOBAL IVAN
Entity Type:Individual
Prefix:DR
First Name:CRISTOBAL
Middle Name:IVAN
Last Name:MENDEZ RUIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ANDRES MENDEZ LICIAGA
Mailing Address - Street 2:#6 A
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685
Mailing Address - Country:US
Mailing Address - Phone:787-585-0450
Mailing Address - Fax:787-896-2160
Practice Address - Street 1:CALLE ANDRES MENDEZ LICIAGA
Practice Address - Street 2:#6 A
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-585-0450
Practice Address - Fax:787-896-2160
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16796208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice