Provider Demographics
NPI:1063550861
Name:JORGE L MENDEZ COLON
Entity type:Organization
Organization Name:JORGE L MENDEZ COLON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MENDEZ COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-877-7700
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0388
Mailing Address - Country:US
Mailing Address - Phone:787-877-1236
Mailing Address - Fax:787-877-1236
Practice Address - Street 1:CARR 111 KM 3.5 INTERIOR
Practice Address - Street 2:EDIFICIO VALE COLON
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-1236
Practice Address - Fax:787-877-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR849291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
800357OtherMMM
30936OtherTRIPLE S
583671509OtherMAPFRE PR
583671509OtherIMC
20033OtherPMC
31903OtherPROSSAM
583671509OtherMAPFRE MEDICARE EXCELL
20006OtherAMERICAN HEALTH
583671509OtherCIGNA
6760017OtherHUMANA
583671509OtherIMC