Healthcare Provider Details

I. General information

NPI: 1134516024
Provider Name (Legal Business Name): FABIA MENDOZA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2015
Last Update Date: 02/20/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 AVE ANTONIO R BARCELO STE 209
CAYEY PR
00736-4107
US

IV. Provider business mailing address

PO BOX 3172
BAYAMON PR
00960-3172
US

V. Phone/Fax

Practice location:
  • Phone: 787-635-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3251
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: