Provider Demographics
NPI:1902266760
Name:ANA W. GONZALEZ MENDEZ
Entity Type:Organization
Organization Name:ANA W. GONZALEZ MENDEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GONZALEZ MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-378-1891
Mailing Address - Street 1:2 CALLE BENITO FEIJOO
Mailing Address - Street 2:VILLAS DEL ESTE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-378-1891
Mailing Address - Fax:
Practice Address - Street 1:K5 CALLE LA VICTORIA
Practice Address - Street 2:CITY PALACE
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-378-1891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3237261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)