Provider Demographics
NPI:1780728873
Name:MENDOZA, RAFAEL ORLANDO (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ORLANDO
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37 CALLE MAGA URB VALLE HUCARES
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-260-7204
Mailing Address - Fax:
Practice Address - Street 1:606 TITO CASTRO LA RAMBLA PLAZA
Practice Address - Street 2:SUITE 233
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-840-6838
Practice Address - Fax:787-840-6838
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14244208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14244OtherMEDICAL LICENSE