Basic Information
Provider Information
NPI: 1003008517
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MENDEZ
FirstName: DANIEL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CRUZ
OtherFirstName: DANIEL
OtherMiddleName: MENDEZ
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 5
Mailing Information
Address1: 100 AVE LUIS MUNOZ MARIN
Address2:  
City: CAGUAS
State: PR
PostalCode: 007256184
CountryCode: US
TelephoneNumber: 7876533434
FaxNumber:  
Practice Location
Address1: 100 AVE LUIS MUNOZ MARIN
Address2:  
City: CAGUAS
State: PR
PostalCode: 007256184
CountryCode: US
TelephoneNumber: 7876533434
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2007
LastUpdateDate: 06/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085B0100X17067PRY Allopathic & Osteopathic PhysiciansRadiologyBody Imaging
2085R0202X26630PRN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202XMD433674PAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
102137465-000105PA MEDICAID


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