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General NPI Number Information
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NPI Number | 1578215919
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Entity Type | Individual
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Provider Name | MR. LUIS A MENDEZ
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Gender | Male
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | CARR. 112 KM 1.2 BO. PUEBLO
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City | ISABELA
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State | PR
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Zip | 00662-0066
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Country | US
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Telephone | 939-319-5621
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14
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City | MOCA
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State | PR
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Zip | 00676-0014
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Country | US
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Telephone | 939-331-9562
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Fax |
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6674
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License Number State | PR
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