Provider Demographics
NPI:1558638445
Name:MENDEZ, MARTA TERESA
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:TERESA
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. DORADO DEL MAR
Mailing Address - Street 2:LL-12 BLVD. ST.
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2320
Mailing Address - Country:US
Mailing Address - Phone:787-604-8318
Mailing Address - Fax:
Practice Address - Street 1:DORADO DEL MAR
Practice Address - Street 2:LL-12 BLVD. ST.
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-2320
Practice Address - Country:US
Practice Address - Phone:787-604-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1916103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist