Provider Demographics
NPI:1659367746
Name:MENDEZ, JORGE L (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:MENDEZ
Suffix:
Gender:M
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:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-3677
Mailing Address - Country:US
Mailing Address - Phone:787-791-5712
Mailing Address - Fax:787-253-3689
Practice Address - Street 1:41 PISCIS
Practice Address - Street 2:URB LOS ANGELES
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-1105
Practice Address - Country:US
Practice Address - Phone:787-791-5712
Practice Address - Fax:787-253-3689
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5572208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25890Medicare ID - Type Unspecified
PRC79494Medicare UPIN