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General NPI Number Information
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NPI Number | 1366558397
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Entity Type | Individual
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Provider Name | DOMINGO A MENDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | URB. VILLA REAL CALLE 2 B-11
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-858-1156
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Fax | 787-858-1156
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Provider Business Mailing Address
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Address Line | PO BOX 857
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City | MANATI
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State | PR
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Zip | 00674-0857
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Country | US
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Telephone | 787-858-1156
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Fax | 787-858-1156
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4873
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License Number State | PR
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