Provider Demographics
NPI:1427024389
Name:ROSARIO-MENDOZA, RICARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:ROSARIO-MENDOZA
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:EL SENORIAL MAIL STATION BOX 452
Mailing Address - Street 2:WINSTON CHURCHILL AVE. 138 CROWN HILLS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6023
Mailing Address - Country:US
Mailing Address - Phone:787-767-2038
Mailing Address - Fax:787-758-8096
Practice Address - Street 1:552 CALLE CESAR GONZALEZ
Practice Address - Street 2:EXT. ROOSEVELT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2604
Practice Address - Country:US
Practice Address - Phone:787-753-1510
Practice Address - Fax:787-753-6585
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist