Provider Demographics
NPI:1013682269
Name:HERNANDEZ MENDOZA, ANAITSI (LND)
Entity type:Individual
Prefix:
First Name:ANAITSI
Middle Name:
Last Name:HERNANDEZ MENDOZA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 50380
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 110 KM 12.1 ESQ CALLE MONSENOR TORRES
Practice Address - Street 2:BO PUEBLO HOSP. SAN CARLOS BORROMEO
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9112
Practice Address - Country:US
Practice Address - Phone:787-877-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1968133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered