Provider Demographics
NPI:1619275609
Name:DRA CELIA G MENDEZ, OBGYN, CSP
Entity Type:Organization
Organization Name:DRA CELIA G MENDEZ, OBGYN, CSP
Other - Org Name:DRA CELIA G MENDEZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-753-0424
Mailing Address - Street 1:URB MANSIONES DE RIO PIEDRAS
Mailing Address - Street 2:1174 HORTENSIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-1174
Mailing Address - Country:US
Mailing Address - Phone:787-753-0424
Mailing Address - Fax:787-753-0545
Practice Address - Street 1:PARQ CENTRAL
Practice Address - Street 2:SUITE 3 568 JUAN J JIMENEZ
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2676
Practice Address - Country:US
Practice Address - Phone:787-753-0424
Practice Address - Fax:787-753-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG37597Medicare UPIN