Provider Demographics
NPI:1316328107
Name:MENDIETA, KATHY SOFIA (MD)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:SOFIA
Last Name:MENDIETA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BOULEVARD DR GUILLERMO ARBONA CENTRO MEDICO
Mailing Address - Street 2:SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00935-5067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BOULEVARD DR GUILLERMO ARBONA CENTRO MEDICO
Practice Address - Street 2:SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-5067
Practice Address - Country:US
Practice Address - Phone:787-777-3201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
PR19951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program