Provider Demographics
NPI:1003058470
Name:MENDOZA-FERNANDEZ, AILEEN MARLENY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AILEEN
Middle Name:MARLENY
Last Name:MENDOZA-FERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 SW 81ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2128
Mailing Address - Country:US
Mailing Address - Phone:305-297-9445
Mailing Address - Fax:305-269-3989
Practice Address - Street 1:2655 S LE JEUNE RD
Practice Address - Street 2:#530
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5832
Practice Address - Country:US
Practice Address - Phone:305-297-9445
Practice Address - Fax:305-269-3989
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7893103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical