Provider Demographics
NPI:1386680957
Name:MENDOZA, VERONICA (MD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:MENDOZA
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:ARBOLES DE MONTEHIEDRA
Mailing Address - Street 2:BLVD 600 BOX 494
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-648-3180
Mailing Address - Fax:787-745-1702
Practice Address - Street 1:ARBOLES DE MONTEHIEDRA
Practice Address - Street 2:BLVD 600 BOX 494
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-648-3180
Practice Address - Fax:787-745-1702
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG39866Medicare UPIN
PR0088827Medicare ID - Type Unspecified