Provider Demographics
NPI:1548471394
Name:MENDEZ, ROSA HAYDEE
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:HAYDEE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 4058
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-9346
Mailing Address - Country:US
Mailing Address - Phone:787-420-6530
Mailing Address - Fax:
Practice Address - Street 1:345 CALLE POST S
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-2389
Practice Address - Country:US
Practice Address - Phone:787-831-2212
Practice Address - Fax:787-805-3875
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6211183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician