Provider Demographics
NPI:1427894138
Name:IZQUIERDO MENDEZ, MICHEL
Entity type:Individual
Prefix:
First Name:MICHEL
Middle Name:
Last Name:IZQUIERDO 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 1:326 PEERLESS ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974
Mailing Address - Country:US
Mailing Address - Phone:786-616-5473
Mailing Address - Fax:
Practice Address - Street 1:326 PEERLESS ST
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974
Practice Address - Country:US
Practice Address - Phone:786-616-5473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician