Healthcare Provider Details

I. General information

NPI: 1861367088
Provider Name (Legal Business Name): SISTEMA UNIVERSITARIO ANA G MENDEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 931 KM 0.4 BO NAVARRO
GURABO PR
00778-3030
US

IV. Provider business mailing address

PO BOX 3030
GURABO PR
00778-3030
US

V. Phone/Fax

Practice location:
  • Phone: 787-743-7979
  • Fax:
Mailing address:
  • Phone: 787-743-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY ESCALONA
Title or Position: DECANA
Credential: DMD
Phone: 713-294-0525