1063550861 NPI number — JORGE L MENDEZ COLON

Table of content: (NPI 1063550861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063550861 NPI number — JORGE L MENDEZ COLON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JORGE L MENDEZ COLON
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:
Provider Other Organization Name Type Code:
6
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:
1063550861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 388
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOCA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00676-0388
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-877-1236
Provider Business Mailing Address Fax Number:
787-877-1236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 111 KM 3.5 INTERIOR
Provider Second Line Business Practice Location Address:
EDIFICIO VALE COLON
Provider Business Practice Location Address City Name:
MOCA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-877-1236
Provider Business Practice Location Address Fax Number:
787-877-1236
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MENDEZ COLON
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
787-877-7700

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  849 , 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)

  • Identifier: 800357 . This is a "MMM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30936 . This is a "TRIPLE S" identifier . This identifiers is of the category "OTHER".
  • Identifier: 583671509 . This is a "MAPFRE PR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 583671509 . This is a "IMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20033 . This is a "PMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 31903 . This is a "PROSSAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 583671509 . This is a "MAPFRE MEDICARE EXCELL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20006 . This is a "AMERICAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 583671509 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6760017 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".




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