Provider Demographics
NPI:1073353132
Name:LA NUEZ MENDEZ, LIANET
Entity type:Individual
Prefix:
First Name:LIANET
Middle Name:
Last Name:LA NUEZ MENDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16901 SW 109TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-9030
Mailing Address - Country:US
Mailing Address - Phone:305-741-9603
Mailing Address - Fax:
Practice Address - Street 1:16901 SW 109TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-9030
Practice Address - Country:US
Practice Address - Phone:305-741-9603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24347488106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician