Basic Information
Provider Information
NPI: 1033557194
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MENDEZ
FirstName: CRISTINA
MiddleName: M. GONZALEZ GONZALEZ
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: HC 4 BOX 41805
Address2:  
City: MAYAGUEZ
State: PR
PostalCode: 006809703
CountryCode: US
TelephoneNumber: 7875125123
FaxNumber:  
Practice Location
Address1: HC 4 BOX 41805
Address2:  
City: MAYAGUEZ
State: PR
PostalCode: 006809703
CountryCode: US
TelephoneNumber: 7875125123
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/11/2013
LastUpdateDate: 06/11/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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