Provider Demographics
NPI:1649247008
Name:MENDEZ COCA, PROVIADELA (MS)
Entity type:Individual
Prefix:MRS
First Name:PROVIADELA
Middle Name:
Last Name:MENDEZ COCA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 AVE DOMENECH
Mailing Address - Street 2:SUITE # 206
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3523
Mailing Address - Country:US
Mailing Address - Phone:787-758-6780
Mailing Address - Fax:787-758-6780
Practice Address - Street 1:207 AVE DOMENECH
Practice Address - Street 2:SUITE # 206
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3523
Practice Address - Country:US
Practice Address - Phone:787-758-6780
Practice Address - Fax:787-758-6780
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPR152231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist