Healthcare Provider Details

I. General information

NPI: 1760503262
Provider Name (Legal Business Name): RAQUEL MENDIOLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CALLE TANAGRA URB. APOLO
GUAYNABO PR
00969-5029
US

IV. Provider business mailing address

37 CALLE TANAGRA URB. APOLO
GUAYNABO PR
00969-5029
US

V. Phone/Fax

Practice location:
  • Phone: 787-607-1268
  • Fax:
Mailing address:
  • Phone: 787-789-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3224
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: