Healthcare Provider Details

I. General information

NPI: 1689401309
Provider Name (Legal Business Name): JUAN FELIPE MENDEZ LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 365067
SAN JUAN PR
00936-5067
US

IV. Provider business mailing address

3205 AVE ISLA VERDE COND GALAXY APT 203
CAROLINA PR
00979
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-2363
  • Fax:
Mailing address:
  • Phone: 787-413-8959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25154
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: