Provider Demographics
NPI:1205967437
Name:MENDEZ, MARISOL (MT)
Entity type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 AVE SEVERIANO CUEVAS STE 101
Mailing Address - Street 2:AGUADILLA MEDICAL PLAZA
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5762
Mailing Address - Country:US
Mailing Address - Phone:787-891-1481
Mailing Address - Fax:787-891-1481
Practice Address - Street 1:24 AVE SEVERIANO CUEVAS STE 101
Practice Address - Street 2:AGUADILLA MEDICAL PLAZA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5762
Practice Address - Country:US
Practice Address - Phone:787-891-1481
Practice Address - Fax:787-891-1481
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR309291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory