MEDICARE: JAVIER A MENDEZ RUIZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	18237	PR

General Provider Information

NPI Number	:	1205086410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER A MENDEZ RUIZ MD

Provider Business Mailing Address
First Line	:	OFFICE PARK # I
Second Line	:	349 AVE. HOSTOS SUITE 102-D
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-1509
Country	:	US
Telephone Number	:	787-832-5748
Fax Number	:	787-832-5994

Provider Business Practice Location Address
First Line	:	OFFICE PARK # I
Second Line	:	349 AVE. HOSTOS SUITE 102-D
City	:	MAYAGUEZ
State	:	PR
Zip	:	00680-1509
Country	:	US
Telephone Number	:	787-832-5748
Fax Number	:	787-832-5994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	08/24/2015

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