MEDICARE: DR. JORGE MENDEZ -LOPEZ M.D.

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	208D00000X	General Practice Physician	14861	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14861	OTHER	PR	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1205833274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE MENDEZ -LOPEZ M.D.

Provider Business Mailing Address
First Line	:	1640 CALLE TAMESIS
Second Line	:	EL PARAISO
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2953
Country	:	US
Telephone Number	:	787-402-3757
Fax Number	:	787-292-6953

Provider Business Practice Location Address
First Line	:	41 CALLE PISCIS
Second Line	:	URB. LOS ANGELES
City	:	CAROLINA
State	:	PR
Zip	:	00979-1620
Country	:	US
Telephone Number	:	787-791-5712
Fax Number	:	787-253-3689

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	11/25/2009

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