Basic Information
Provider Information
NPI: 1659330405
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MENDEZ
FirstName: REBECA
MiddleName: I
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 11913
Address2:  
City: SAN JUAN
State: PR
PostalCode: 009221913
CountryCode: US
TelephoneNumber: 7879990753
FaxNumber: 7878417228
Practice Location
Address1: 917 AVE TITO CASTRO
Address2:  
City: PONCE
State: PR
PostalCode: 00716
CountryCode: US
TelephoneNumber: 7878446060
FaxNumber: 7878417228
Other Information
ProviderEnumerationDate: 03/21/2006
LastUpdateDate: 12/11/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/11/2019

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X13160PRN Allopathic & Osteopathic PhysiciansHospitalist 
2080N0001X13160PRY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine

No ID Information.


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