Provider Demographics
NPI:1932259785
Name:MENDEZ, CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
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:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-0176
Mailing Address - Country:US
Mailing Address - Phone:787-874-3332
Mailing Address - Fax:787-874-5433
Practice Address - Street 1:OFICINA MEDICA
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-874-3332
Practice Address - Fax:787-874-5433
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7743207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRA048OtherINTERNATIONAL MEDICAL CAR
PRH60233Medicare UPIN
PRA048OtherINTERNATIONAL MEDICAL CAR