Healthcare Provider Details

I. General information

NPI: 1891126744
Provider Name (Legal Business Name): SAMUEL VELORIA MENDOZA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USNH GUANTANAMO BAY BOX 161
FPO AE
09589-9997
US

IV. Provider business mailing address

USNH GUANTANAMO BAY BOX 161
FPO AE
09589-9997
US

V. Phone/Fax

Practice location:
  • Phone: 01153992360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number70095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: