Healthcare Provider Details

I. General information

NPI: 1023323698
Provider Name (Legal Business Name): MRS. KRYSTHEL KEYLA MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2010
Last Update Date: 08/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 2 BOX 21541
SAN SEBASTIAN PR
00685-9229
US

IV. Provider business mailing address

HC 2 BOX 21541
SAN SEBASTIAN PR
00685-9229
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-1850
  • Fax:
Mailing address:
  • Phone: 787-317-5185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number8369
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: