Healthcare Provider Details

I. General information

NPI: 1861301889
Provider Name (Legal Business Name): KIMBERLY MENDEZ GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAR 444 KM 5.5 BO CUCHILLAS SECT MUNIZ
MOCA PR
00676
US

IV. Provider business mailing address

HC 5 BOX 10607
MOCA PR
00676-9807
US

V. Phone/Fax

Practice location:
  • Phone: 787-233-4893
  • Fax:
Mailing address:
  • Phone: 787-233-4893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2900
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: