Provider Demographics
NPI:1487446431
Name:MEZQUIA LUACES, TAIMELY
Entity type:Individual
Prefix:
First Name:TAIMELY
Middle Name:
Last Name:MEZQUIA LUACES
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 1:390 N ROYAL POINCIANA BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4476
Mailing Address - Country:US
Mailing Address - Phone:786-747-8982
Mailing Address - Fax:
Practice Address - Street 1:390 N ROYAL POINCIANA BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-4476
Practice Address - Country:US
Practice Address - Phone:786-747-8982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-436089106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician