Provider Demographics
NPI:1154140572
Name:SANTOS MENDEZ, MABDIEL IRAN
Entity type:Individual
Prefix:
First Name:MABDIEL
Middle Name:IRAN
Last Name:SANTOS 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 1:777 NW 72ND AVE STE 1083
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3176
Mailing Address - Country:US
Mailing Address - Phone:305-342-7643
Mailing Address - Fax:
Practice Address - Street 1:10511 SW 108TH AVE APT 191
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-8192
Practice Address - Country:US
Practice Address - Phone:786-839-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician