Provider Demographics
NPI:1710171376
Name:WALDEMAR ROSARIO MENDEZ
Entity Type:Organization
Organization Name:WALDEMAR ROSARIO MENDEZ
Other - Org Name:WALDEMAR ROSARIO MENDEZ
Other - Org Type:Other Name
Authorized Official - Title/Position:PROPIETARIO
Authorized Official - Prefix:
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:TEM P
Authorized Official - Phone:787-201-1246
Mailing Address - Street 1:HC 2 BOX 7732
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-9812
Mailing Address - Country:US
Mailing Address - Phone:787-623-4984
Mailing Address - Fax:787-623-4984
Practice Address - Street 1:E1 URB SAN FRANCISCO
Practice Address - Street 2:CALLE 3 E-1
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-3086
Practice Address - Country:US
Practice Address - Phone:787-623-4984
Practice Address - Fax:787-623-4984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058839Medicare PIN