Provider Demographics
NPI:1932472529
Name:MENDEZ, JOSE LUIS JR (CONTRACTOR)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:MENDEZ
Suffix:JR
Gender:M
Credentials:CONTRACTOR
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 2008
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-7008
Mailing Address - Country:US
Mailing Address - Phone:956-342-6460
Mailing Address - Fax:956-283-1239
Practice Address - Street 1:913 SUNDANCE LN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-4949
Practice Address - Country:US
Practice Address - Phone:956-342-6460
Practice Address - Fax:956-283-1239
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1230171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications