Provider Demographics
NPI:1326305715
Name:MENDEZ GUERRA, IVELISSE
Entity Type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:MENDEZ GUERRA
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:PMB 2275
Mailing Address - Street 2:PO BOX 6029
Mailing Address - City:CAROLINA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00984
Mailing Address - Country:UM
Mailing Address - Phone:787-550-7860
Mailing Address - Fax:
Practice Address - Street 1:CORPORACION DEL FONDO DEL SEGURO DEL ESTADO
Practice Address - Street 2:CARR #3, 65TH INFANTERIA SECTOR COMUNIDAD ESCORIAL
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002765183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4214329OtherDRIVERS LICENCE