Provider Demographics
NPI:1891786760
Name:MENDOZA VILLAHERMOSA, ODALYS (MD)
Entity Type:Individual
Prefix:DR
First Name:ODALYS
Middle Name:
Last Name:MENDOZA VILLAHERMOSA
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:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1510
Mailing Address - Country:US
Mailing Address - Phone:787-743-3886
Mailing Address - Fax:787-286-5180
Practice Address - Street 1:HIMA PLAZA UNO OFICINA 411
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-3886
Practice Address - Fax:787-286-5180
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11140207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF63544Medicare UPIN
PR0083448Medicare PIN