Provider Demographics
NPI:1922299304
Name:MENDOZA, ANNETTE (PH)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 24, 3RA VILLA CAROLINA
Mailing Address - Street 2:#76-10
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-757-1404
Mailing Address - Fax:
Practice Address - Street 1:CALLE 24, 3RA VILLA CAROLINA
Practice Address - Street 2:#76-10
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-757-1404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR004203OtherLICENSE
PR066038OtherREGISTRATION