Provider Demographics
NPI:1306482468
Name:LOPEZ MENDEZ, JAVIER
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:LOPEZ MENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7032 AVE AGUSTIN RAMOS CALERO
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3432
Mailing Address - Country:US
Mailing Address - Phone:787-429-5905
Mailing Address - Fax:
Practice Address - Street 1:7032 AVE AGUSTIN RAMOS CALERO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3432
Practice Address - Country:US
Practice Address - Phone:787-429-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist