Provider Demographics
NPI:1447933288
Name:MENDEZ, ELDIS MICHELLE (BA)
Entity type:Individual
Prefix:MRS
First Name:ELDIS
Middle Name:MICHELLE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 COND PARQ JULIANA APT 305
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8277
Mailing Address - Country:US
Mailing Address - Phone:787-637-4721
Mailing Address - Fax:
Practice Address - Street 1:151 CALLE DE LA TANCA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901-1412
Practice Address - Country:US
Practice Address - Phone:787-725-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program