Provider Demographics
NPI:1609197623
Name:MENDEZ, LUZ YOLANDA (MD)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:YOLANDA
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MEDICAL PARK DR STE 207
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4778
Mailing Address - Country:US
Mailing Address - Phone:843-383-5171
Mailing Address - Fax:843-878-0068
Practice Address - Street 1:701 MEDICAL PARK DR STE 207
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4778
Practice Address - Country:US
Practice Address - Phone:843-383-5171
Practice Address - Fax:843-878-0068
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2013-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL32800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine