Provider Demographics
NPI:1982564159
Name:REY MENDEZ, LAURA IDALMIS
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:IDALMIS
Last Name:REY MENDEZ
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 1:7502 W 30TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5200
Mailing Address - Country:US
Mailing Address - Phone:786-821-8863
Mailing Address - Fax:
Practice Address - Street 1:7502 W 30TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5200
Practice Address - Country:US
Practice Address - Phone:786-821-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-486797106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician