1316012495 NPI number — MR. JUAN A MENDOZA ORTIZ SR. MD

Table of content: MR. JUAN A MENDOZA ORTIZ SR. MD (NPI 1316012495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316012495 NPI number — MR. JUAN A MENDOZA ORTIZ SR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDOZA ORTIZ
Provider First Name:
JUAN
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1316012495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUES
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-5430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-743-7153
Provider Business Mailing Address Fax Number:
787-743-7153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OFICINA 203 EDIFICIO PROFESIONAL
Provider Second Line Business Practice Location Address:
HOSPITAL MENONITA CAYEY
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-263-1010
Provider Business Practice Location Address Fax Number:
787-743-7153
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  8289 , 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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