Provider Demographics
NPI:1952581688
Name:VALENTIN-MENDOZA, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:VALENTIN-MENDOZA
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:COND MALAGA PARK
Mailing Address - Street 2:14 AVE. JUAN MARTINEZ APT 77
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9730
Mailing Address - Country:US
Mailing Address - Phone:787-579-5096
Mailing Address - Fax:
Practice Address - Street 1:COND MALAGA PARK
Practice Address - Street 2:14 AVE. JUAN MARTINEZ APT 77
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-9730
Practice Address - Country:US
Practice Address - Phone:787-579-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16957207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHG739AMedicare PIN