1619275609 NPI number — DRA CELIA G MENDEZ, OBGYN, CSP

Table of content: (NPI 1619275609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619275609 NPI number — DRA CELIA G MENDEZ, OBGYN, CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRA CELIA G MENDEZ, OBGYN, CSP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DRA CELIA G MENDEZ
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619275609
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB MANSIONES DE RIO PIEDRAS
Provider Second Line Business Mailing Address:
1174 HORTENSIA
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-1174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-753-0424
Provider Business Mailing Address Fax Number:
787-753-0545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PARQ CENTRAL
Provider Second Line Business Practice Location Address:
SUITE 3 568 JUAN J JIMENEZ
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00918-2676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-753-0424
Provider Business Practice Location Address Fax Number:
787-753-0545
Provider Enumeration Date:
03/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MENDEZ
Authorized Official First Name:
CELIA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-753-0424

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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