Provider Demographics
NPI:1124252259
Name:MONDRAGON, JESSICA VANESSA
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:VANESSA
Last Name:MONDRAGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 STIRLING RD APT 611
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1531
Mailing Address - Country:US
Mailing Address - Phone:954-821-7883
Mailing Address - Fax:
Practice Address - Street 1:594 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7615
Practice Address - Country:US
Practice Address - Phone:954-344-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst