Provider Demographics
NPI:1629324926
Name:MENDEZ MONGES, MILDRED (MSED)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:MENDEZ MONGES
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10934 113TH ST
Mailing Address - Street 2:1FT
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1121
Mailing Address - Country:US
Mailing Address - Phone:646-421-0959
Mailing Address - Fax:
Practice Address - Street 1:10934 113TH ST
Practice Address - Street 2:1FT
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1121
Practice Address - Country:US
Practice Address - Phone:646-421-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY713792174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator