Provider Demographics
NPI:1194088138
Name:FELIZ, MAYRA (SPECIAL EDUCATOR)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:FELIZ
Suffix:
Gender:F
Credentials:SPECIAL EDUCATOR
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:A
Other - Last Name:FELIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3020 LAWTON AVE
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3425
Mailing Address - Country:US
Mailing Address - Phone:718-775-5096
Mailing Address - Fax:718-918-9257
Practice Address - Street 1:3020 LAWTON AVE
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3425
Practice Address - Country:US
Practice Address - Phone:718-775-5096
Practice Address - Fax:718-918-9257
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSPECIAL EDUCATION174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist