Provider Demographics
NPI:1386092468
Name:MENDOZA, RONALD (MSW)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 DELTONA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:667 DELTONA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8022
Practice Address - Country:US
Practice Address - Phone:386-259-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-30
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker