Provider Demographics
NPI:1780424614
Name:SOLARES MENDOZA, JAN LUIS (ND)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:LUIS
Last Name:SOLARES MENDOZA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CONDOMINIO VEREDAS DEL RIO
Mailing Address - Street 2:APT 306A
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8761
Mailing Address - Country:US
Mailing Address - Phone:787-235-8227
Mailing Address - Fax:
Practice Address - Street 1:VILLA CAROLINA AVENIDA ROBERTO CLEMENTE
Practice Address - Street 2:27-1
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-235-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath