Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 15545 | PR |
NPI | 1033619630 |
---|---|
Provider Name | Israel Jesus Mendez |
First Address | Trujillo Alto, PR 00976-2734 |
Second Address | San Juan, PR 00921-2724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2018 |
Last Update Date | 05/04/2021 |