Provider Demographics
NPI:1285742189
Name:DIAZ MENDEZ, RAFAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:DIAZ MENDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A17 CALLE PALMA SOLA
Mailing Address - Street 2:GARDEN HILLS SUR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2923
Mailing Address - Country:US
Mailing Address - Phone:787-781-0281
Mailing Address - Fax:
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:SUITE 502
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-756-5252
Practice Address - Fax:787-763-4928
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10521223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1052OtherSTATE LIC. #