Provider Demographics
NPI:1104598440
Name:MENDEZ VAZQUEZ, HEIDY
Entity type:Individual
Prefix:
First Name:HEIDY
Middle Name:
Last Name:MENDEZ VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050
Mailing Address - Street 2:CONDOMINIO PORTALES ALBELI BUZON 704
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-0724
Mailing Address - Country:US
Mailing Address - Phone:787-342-1320
Mailing Address - Fax:
Practice Address - Street 1:107
Practice Address - Street 2:CONDOMINIO DARLINGTON AVE LUIS MUNOZ RIVERA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-342-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty