Provider Demographics
NPI:1912169632
Name:MENDEZ, JORGE I (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:I
Last Name:MENDEZ
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:CARR 111 KM 30.3
Mailing Address - Street 2:BARRIO JUNCAL HC03 BOX 35468
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-7565
Mailing Address - Country:US
Mailing Address - Phone:939-969-2479
Mailing Address - Fax:
Practice Address - Street 1:CARR 111 KM 30.3
Practice Address - Street 2:BARRIO JUNCAL HC03 BOX 35468
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-7565
Practice Address - Country:US
Practice Address - Phone:939-969-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17154208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice