Provider Demographics
NPI:1235129826
Name:MENDEZ-BEAUCHAMP, VICTOR M (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:MENDEZ-BEAUCHAMP
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:TORRE PLAZA LAS AMERICAS
Mailing Address - Street 2:SUITE 605
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-753-7189
Mailing Address - Fax:787-764-4253
Practice Address - Street 1:TORRE PLAZA LAS AMERICAS
Practice Address - Street 2:SUITE 605
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-753-7189
Practice Address - Fax:787-764-4253
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2681207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C83754Medicare UPIN
PR93291Medicare ID - Type Unspecified