1003058470 NPI number — DR. AILEEN MARLENY MENDOZA-FERNANDEZ PSY.D

Table of content: DR. AILEEN MARLENY MENDOZA-FERNANDEZ PSY.D (NPI 1003058470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003058470 NPI number — DR. AILEEN MARLENY MENDOZA-FERNANDEZ PSY.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDOZA-FERNANDEZ
Provider First Name:
AILEEN
Provider Middle Name:
MARLENY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003058470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94 SW 81ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33144-2128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-297-9445
Provider Business Mailing Address Fax Number:
305-269-3989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2655 S LE JEUNE RD
Provider Second Line Business Practice Location Address:
#530
Provider Business Practice Location Address City Name:
CORAL GABLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33134-5832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-297-9445
Provider Business Practice Location Address Fax Number:
305-269-3989
Provider Enumeration Date:
04/01/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PY7893 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)