Provider Demographics
NPI:1811128341
Name:MENDEZ SERVERA, JUAN E (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:E
Last Name:MENDEZ SERVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB.LA MONSERRATE ST.7 H-6
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:787-930-5057
Mailing Address - Fax:787-892-4822
Practice Address - Street 1:ST.7 URB.LA MONSERRATE H-6
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-930-5057
Practice Address - Fax:787-892-4822
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17672208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice