Provider Demographics
NPI:1619393741
Name:MENDEZ, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 W FARMS RD
Mailing Address - Street 2:APT 2E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-1651
Mailing Address - Country:US
Mailing Address - Phone:347-260-3929
Mailing Address - Fax:
Practice Address - Street 1:1316 W FARMS RD
Practice Address - Street 2:APT 2E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-1651
Practice Address - Country:US
Practice Address - Phone:347-260-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator