Provider Demographics
NPI:1629197256
Name:MENDEZ, OLGA IRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:IRIS
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 1:1672 CALLE VIOLETA
Mailing Address - Street 2:
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6243
Mailing Address - Country:US
Mailing Address - Phone:787-612-7076
Mailing Address - Fax:787-754-8002
Practice Address - Street 1:ACTU PROJECT BIOMEDICAL BUILDING # 2 P R MEDICAL
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-767-9192
Practice Address - Fax:787-758-0955
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9937261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center