Provider Demographics
NPI:1528785854
Name:MENDOZA, CLAUDIA VIRGINIA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:VIRGINIA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:VIRGINIA
Other - Last Name:CORRALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:551 SW 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1142
Mailing Address - Country:US
Mailing Address - Phone:786-306-8040
Mailing Address - Fax:
Practice Address - Street 1:13500 SW 88TH ST STE 285
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1515
Practice Address - Country:US
Practice Address - Phone:786-409-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA22084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116059110Medicaid