Healthcare Provider Details

I. General information

NPI: 1407851298
Provider Name (Legal Business Name): ERLANDO MENDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 06/14/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA HATO ARRIBA CARR 111 KM 14.5 OFICINA #4
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

PO BOX 5346
SAN SEBASTIAN PR
00685-5346
US

V. Phone/Fax

Practice location:
  • Phone: 787-280-7029
  • Fax: 787-280-7029
Mailing address:
  • Phone: 787-280-7029
  • Fax: 787-280-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10646
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number10646
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: