MEDICARE: JONATHAN MENDEZ

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	314000000X	Skilled Nursing Facility	000845	CT

General Provider Information

NPI Number	:	1518119387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN MENDEZ

Provider Business Mailing Address
First Line	:	185 CHESTER ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-2816
Country	:	US
Telephone Number	:	860-371-6448
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 CHESTER ST
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-2816
Country	:	US
Telephone Number	:	860-371-6448
Fax Number	:

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

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	10/10/2008

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