Provider Demographics
NPI:1841673803
Name:MENDEZ FERNANDEZ, ANGELIE (PTA, BHE)
Entity type:Individual
Prefix:MS
First Name:ANGELIE
Middle Name:
Last Name:MENDEZ FERNANDEZ
Suffix:
Gender:F
Credentials:PTA, BHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I21 CALLE 10
Mailing Address - Street 2:URBANIZACION VILLA DEL CARMEN
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-3034
Mailing Address - Country:US
Mailing Address - Phone:787-608-9959
Mailing Address - Fax:
Practice Address - Street 1:I21 CALLE 10
Practice Address - Street 2:URBANIZACION VILLA DEL CARMEN
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3034
Practice Address - Country:US
Practice Address - Phone:787-608-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5068-1174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator