Provider Demographics
NPI:1639788474
Name:MENDEZ, EDWIN EMMANUEL
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:EMMANUEL
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EDWIN
Other - Middle Name:EMMANUEL
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1174
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1174
Mailing Address - Country:US
Mailing Address - Phone:939-276-3183
Mailing Address - Fax:
Practice Address - Street 1:550 CALLE CONCEPCION VERA
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-5005
Practice Address - Country:US
Practice Address - Phone:787-877-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR23496207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program