Provider Demographics
NPI:1265785562
Name:MENDEZ, JUAN MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MANUEL
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:M
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7750 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 120-345
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7514
Mailing Address - Country:US
Mailing Address - Phone:214-986-4900
Mailing Address - Fax:972-432-8015
Practice Address - Street 1:7750 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 120-345
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7514
Practice Address - Country:US
Practice Address - Phone:214-986-4900
Practice Address - Fax:972-432-8015
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038370207R00000X
CAG390892083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine