Provider Demographics
NPI:1902815517
Name:MENDEZ-LATALLADI, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:MENDEZ-LATALLADI
Suffix:
Gender:M
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 79429
Mailing Address - Street 2:ISLA VERDE STATION
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-9429
Mailing Address - Country:US
Mailing Address - Phone:787-331-6269
Mailing Address - Fax:787-758-1119
Practice Address - Street 1:AMERICO MIRANDA AVE.
Practice Address - Street 2:REPARTO SHOPPING CENTER 3RD FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:787-758-1119
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG59606Medicare UPIN