Healthcare Provider Details

I. General information

NPI: 1710171376
Provider Name (Legal Business Name): WALDEMAR ROSARIO MENDEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E1 URB SAN FRANCISCO CALLE 3 E-1
BARCELONETA PR
00617-3086
US

IV. Provider business mailing address

HC 2 BOX 7732
BARCELONETA PR
00617-9812
US

V. Phone/Fax

Practice location:
  • Phone: 787-623-4984
  • Fax: 787-623-4984
Mailing address:
  • Phone: 787-623-4984
  • Fax: 787-623-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: WALDEMAR ROSARIO MENDEZ
Title or Position: PROPIETARIO
Credential: TEM P
Phone: 787-201-1246