Provider Demographics
NPI:1568695757
Name:MENDEZ, SALVADOR (DO)
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:SAL
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:169 ASHLEY AVE RM 202
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8905
Mailing Address - Country:US
Mailing Address - Phone:956-618-4414
Mailing Address - Fax:956-618-4424
Practice Address - Street 1:169 ASHLEY AVE RM 202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425
Practice Address - Country:US
Practice Address - Phone:956-618-4414
Practice Address - Fax:956-618-4424
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL52074207R00000X
TXPA06381363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568695757OtherNPI
TX8L23619Medicare PIN