Provider Demographics
NPI:1487870572
Name:MENDEZ, ASUNCION (MD)
Entity type:Individual
Prefix:
First Name:ASUNCION
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASUNCION
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 3411
Mailing Address - Street 2:VALLE ARRIBA HEIGHTS STA.
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984
Mailing Address - Country:US
Mailing Address - Phone:787-409-2404
Mailing Address - Fax:
Practice Address - Street 1:STREET 70, BLOCK 129, VILLA CAROLINA
Practice Address - Street 2:SUITE NUMBER 26
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-769-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004136261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR004136OtherLICENSE NUMBER
PR2004-005801OtherREGISTER NUMBER