Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 9887 | PR |
NPI | 1407828619 |
---|---|
Provider Name | Mr. Samuel Mendez |
First Address | Mayaguez, PR 00680 |
Second Address | Mayaguez, PR 00680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 18/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F58896 | (02) |