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1205577145 NPI number — ANGIE VERONICA HEREDIA MENDEZ MD

NPI Number: 1205577145
Health Care Provider/Practitioner: ANGIE VERONICA HEREDIA MENDEZ MD

Information about “1205577145” NPI (ANGIE VERONICA HEREDIA MENDEZ MD) exists in 1205577145 in HTML format HTML  |  1205577145 in plain Text format TXT  |  1205577145 in PDF (Portable Document Format) PDF  |  1205577145 in an XML format XML  formats.

NPI Number : 1205577145 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205577145",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HEREDIA MENDEZ",
    "FirstName": "ANGIE",
    "MiddleName": "VERONICA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "D15 CALLE 6, ESTANCIAS DE SAN FERNANDO",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CAROLINA",
    "MailingAddressStateName": "PR",
    "MailingAddressPostalCode": "00985",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "787-225-3099",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "D15 CALLE 6, ESTANCIAS DE SAN FERNANDO",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CAROLINA",
    "PracticeLocationAddressStateName": "PR",
    "PracticeLocationAddressPostalCode": "00985",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "787-225-3099",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/05/2022",
    "LastUpdateDate": "08/13/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "05/03/2024",
    "NPIReactivationDate": "08/13/2026",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363AM0700X",
        "TaxonomyName": "Medical Physician Assistant",
        "LicenseNumber": "404PA",
        "LicenseNumberStateCode": "PR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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