Provider Demographics
NPI:1285255653
Name:REYES-MENDOZA, JORGE LUIS (RN)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:REYES-MENDOZA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOPEZ SICARDO AVE. BLDG. B18 APT. 208
Mailing Address - Street 2:RES. MANUEL A. PEREZ
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-360-3531
Mailing Address - Fax:
Practice Address - Street 1:LOPEZ SICARDO AVE. BLDG. B18 APT. 208
Practice Address - Street 2:RES. MANUEL A. PEREZ
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-360-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR90122163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty