Provider Demographics
NPI:1942249503
Name:MENDEZ, ROBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:MENDEZ
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 1:2431 AVE LAS AMERICAS
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2113
Mailing Address - Country:US
Mailing Address - Phone:787-842-9345
Mailing Address - Fax:787-841-5872
Practice Address - Street 1:2431 AVE LAS AMERICAS
Practice Address - Street 2:SUITE 206
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2113
Practice Address - Country:US
Practice Address - Phone:787-842-9345
Practice Address - Fax:787-841-5872
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1254582086S0122X
PR125152086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7310257OtherHUMANA PR
PR2400502OtherACAA
PR89076OtherTRIPLE S
PR1049OtherINTERNATIONAL MEDICAL CAR
PR7310257OtherHUMANA PR
PR0089076Medicare ID - Type Unspecified