Provider Demographics
NPI:1447237128
Name:MENDEZ-BRYAN, CARLOS R (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:MENDEZ-BRYAN
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 1:400 ROOSEVELT AVE. SUITE 101
Mailing Address - Street 2:CLINICA LAS AMERICAS
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2129
Mailing Address - Country:US
Mailing Address - Phone:787-765-7713
Mailing Address - Fax:787-250-7967
Practice Address - Street 1:400 ROOSEVELT AVE. SUITE 101
Practice Address - Street 2:CLINICA LAS AMERICAS
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918-2129
Practice Address - Country:US
Practice Address - Phone:787-765-7713
Practice Address - Fax:787-250-7967
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0035302085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77741Medicare UPIN
PR005-5438Medicare ID - Type Unspecified