Provider Demographics
NPI:1407828619
Name:MENDEZ, SAMUEL (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N POST ST
Mailing Address - Street 2:POST CENTER 106
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-834-5500
Mailing Address - Fax:787-834-5677
Practice Address - Street 1:60 N POST ST
Practice Address - Street 2:POST CENTER 106
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-834-5500
Practice Address - Fax:787-834-5677
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR98872084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F58896Medicare UPIN