Provider Demographics
NPI:1215153663
Name:MENDEZ-VILLARRUBIA, JOSE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:MENDEZ-VILLARRUBIA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CALLE PUESTA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-0000
Mailing Address - Country:US
Mailing Address - Phone:787-505-4086
Mailing Address - Fax:
Practice Address - Street 1:61 CALLE MENDEZ VIGO
Practice Address - Street 2:SUITE 3A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-725-5013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5-7530Medicare ID - Type Unspecified