Healthcare Provider Details

I. General information

NPI: 1205577145
Provider Name (Legal Business Name): ANGIE VERONICA HEREDIA MENDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 08/13/2026
Certification Date: 04/05/2022
Deactivation Date: 05/03/2024
Reactivation Date: 08/13/2026

III. Provider practice location address

D15 CALLE 6, ESTANCIAS DE SAN FERNANDO
CAROLINA PR
00985
US

IV. Provider business mailing address

D15 CALLE 6, ESTANCIAS DE SAN FERNANDO
CAROLINA PR
00985
US

V. Phone/Fax

Practice location:
  • Phone: 787-225-3099
  • Fax:
Mailing address:
  • Phone: 787-225-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number404PA
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: