Provider Demographics
NPI:1386784924
Name:MENDOZA, GILBERTO J (MD)
Entity type:Individual
Prefix:
First Name:GILBERTO
Middle Name:J
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 444
Mailing Address - Street 2:PO BOX 70344
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936
Mailing Address - Country:US
Mailing Address - Phone:787-765-2312
Mailing Address - Fax:787-759-8159
Practice Address - Street 1:369 CALLE DE DIEGO
Practice Address - Street 2:SUITE 510
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3003
Practice Address - Country:US
Practice Address - Phone:787-765-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12393207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089007Medicare ID - Type UnspecifiedPHYSICIAN
PRG47436Medicare UPIN