Provider Demographics
NPI:1760503262
Name:MENDIOLA, RAQUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:MENDIOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CALLE TANAGRA
Mailing Address - Street 2:URB. APOLO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5029
Mailing Address - Country:US
Mailing Address - Phone:787-789-6332
Mailing Address - Fax:
Practice Address - Street 1:37 CALLE TANAGRA
Practice Address - Street 2:URB. APOLO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5029
Practice Address - Country:US
Practice Address - Phone:787-607-1268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3224208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics