Provider Demographics
NPI:1407582976
Name:MENDEZ LOZADA, JAVIER ISAI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:ISAI
Last Name:MENDEZ LOZADA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 50 BOX 40288
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9003
Mailing Address - Country:US
Mailing Address - Phone:787-249-7024
Mailing Address - Fax:
Practice Address - Street 1:PALMER STREET #8
Practice Address - Street 2:SUITE #3
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-9003
Practice Address - Country:US
Practice Address - Phone:787-249-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6240103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR00754Medicaid