Provider Demographics
NPI:1942321559
Name:ROSANO MENDEZ, WALDEMAR
Entity Type:Individual
Prefix:
First Name:WALDEMAR
Middle Name:
Last Name:ROSANO MENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB SAN FRANCISCO
Mailing Address - Street 2:E 1 CALLE 3
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-3086
Mailing Address - Country:US
Mailing Address - Phone:787-201-1246
Mailing Address - Fax:
Practice Address - Street 1:URB SAN FRANCISCO
Practice Address - Street 2:E 1 CALLE 3
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-3086
Practice Address - Country:US
Practice Address - Phone:787-201-1246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC ABM 4893416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058839Medicare PIN