Provider Demographics
NPI:1538543988
Name:MEDRANO MENDEZ, CAROLINA MARIA (MD)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:MARIA
Last Name:MEDRANO MENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PAVONIA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2909
Mailing Address - Country:US
Mailing Address - Phone:201-885-3700
Mailing Address - Fax:201-795-1425
Practice Address - Street 1:600 PAVONIA AVE STE 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2909
Practice Address - Country:US
Practice Address - Phone:201-885-3700
Practice Address - Fax:201-795-1425
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09717300174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist