Provider Demographics
NPI:1740498278
Name:MENDEZ-DE JESUS, MIGDALIA (BA)
Entity type:Individual
Prefix:MS
First Name:MIGDALIA
Middle Name:
Last Name:MENDEZ-DE JESUS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DD10 CALLE H
Mailing Address - Street 2:SANTA ELENA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-1701
Mailing Address - Country:US
Mailing Address - Phone:787-787-6466
Mailing Address - Fax:
Practice Address - Street 1:900 CALLE CERRA
Practice Address - Street 2:CDT GUALBERTO RABELL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-5104
Practice Address - Country:US
Practice Address - Phone:787-721-3220
Practice Address - Fax:787-721-3207
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3592104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker