Provider Demographics
NPI:1407830250
Name:VENDRELL, ROBERTO M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:M
Last Name:VENDRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERTO
Other - Middle Name:M
Other - Last Name:VENDRELL WHITNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2320
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-2320
Mailing Address - Country:US
Mailing Address - Phone:787-428-7313
Mailing Address - Fax:
Practice Address - Street 1:#11 CARAZO STREET
Practice Address - Street 2:BAJOS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-0000
Practice Address - Country:US
Practice Address - Phone:787-220-4053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16266207RG0100X, 207R00000X
TXL8221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169858101Medicaid
TX169858101Medicaid
TXI22936Medicare UPIN