Provider Demographics
NPI:1013149814
Name:MENDEZ, JOAQUIN ALBERTO (CDN)
Entity Type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:ALBERTO
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W 28TH ST
Mailing Address - Street 2:17-H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7901
Mailing Address - Country:US
Mailing Address - Phone:646-577-9867
Mailing Address - Fax:
Practice Address - Street 1:365 W 28TH ST
Practice Address - Street 2:17-H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7901
Practice Address - Country:US
Practice Address - Phone:646-577-9867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006233133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist