Provider Demographics
NPI:1841584224
Name:CENTRO DE MEDICINA PRIMARIA Y PREVENTIVA DEL DR CRISTOBAL MENDEZ, INC.
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA PRIMARIA Y PREVENTIVA DEL DR CRISTOBAL MENDEZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:CRISTOBAL
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:MENDEZ RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-896-5738
Mailing Address - Street 1:HC 01 BOX 11465
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-9770
Mailing Address - Country:US
Mailing Address - Phone:787-896-5738
Mailing Address - Fax:787-896-5738
Practice Address - Street 1:BARRIO AIBONITO GUERRERO CARR 447 KM 3.7
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-9770
Practice Address - Country:US
Practice Address - Phone:787-896-5738
Practice Address - Fax:787-896-5738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16796208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty