Healthcare Provider Details

I. General information

NPI: 1740498278
Provider Name (Legal Business Name): MIGDALIA MENDEZ-DE JESUS BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CALLE CERRA CDT GUALBERTO RABELL
SAN JUAN PR
00907-5104
US

IV. Provider business mailing address

DD10 CALLE H SANTA ELENA
BAYAMON PR
00957-1701
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-3220
  • Fax: 787-721-3207
Mailing address:
  • Phone: 787-787-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3592
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: