Provider Demographics
NPI:1215135413
Name:MENDEZ, JOAQUIN R SR (MD)
Entity type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:R
Last Name:MENDEZ
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOAQUIN
Other - Middle Name:
Other - Last Name:MENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1645
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-1645
Mailing Address - Country:US
Mailing Address - Phone:787-615-9292
Mailing Address - Fax:787-886-6847
Practice Address - Street 1:CARR.185 KM5.5 ,BO. CAMPO RICO
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-615-9292
Practice Address - Fax:787-886-6847
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine