Provider Demographics
NPI:1679042527
Name:MENDEZ, BERNICE EDITH (MD TSC)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:EDITH
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MD TSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JARDINES DE VEGA BAJA
Mailing Address - Street 2:C/ FLOR DE MAGA #458
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-393-8443
Mailing Address - Fax:
Practice Address - Street 1:68 CALLE ESTEBAN PADILLA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-6705
Practice Address - Country:US
Practice Address - Phone:787-393-8443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
140031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical