Provider Demographics
NPI:1962256834
Name:MENDOZA RODRIGUEZ, AMY TATIANA
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:TATIANA
Last Name:MENDOZA RODRIGUEZ
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 1:49 NE 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5014
Mailing Address - Country:US
Mailing Address - Phone:786-407-9918
Mailing Address - Fax:
Practice Address - Street 1:5803 NW 151ST ST STE 200B
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2473
Practice Address - Country:US
Practice Address - Phone:305-402-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician