Provider Demographics
NPI:1578215919
Name:MENDEZ, LUIS A
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:A
Last Name:MENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0014
Mailing Address - Country:US
Mailing Address - Phone:939-331-9562
Mailing Address - Fax:
Practice Address - Street 1:CARR. 112 KM 1.2 BO. PUEBLO
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-0066
Practice Address - Country:US
Practice Address - Phone:939-319-5621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6674103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling