Healthcare Provider Details

I. General information

NPI: 1942249503
Provider Name (Legal Business Name): ROBERTO MENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 AVE LAS AMERICAS SUITE 206
PONCE PR
00717-2113
US

IV. Provider business mailing address

2431 AVE LAS AMERICAS SUITE 206
PONCE PR
00717-2113
US

V. Phone/Fax

Practice location:
  • Phone: 787-842-9345
  • Fax: 787-841-5872
Mailing address:
  • Phone: 787-842-9345
  • Fax: 787-841-5872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME125458
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number12515
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: