Provider Demographics
NPI:1043630445
Name:MENDOZA, ARIANNE ANGELA N VICTORIANO (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ARIANNE ANGELA N
Middle Name:VICTORIANO
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:ARIANNE ANGELA N
Other - Middle Name:MENDOZA
Other - Last Name:LEMIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:4411 SW 34TH ST APT 1204
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7554
Mailing Address - Country:US
Mailing Address - Phone:352-346-6254
Mailing Address - Fax:
Practice Address - Street 1:1001 MAR WALT DR # 77
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6780
Practice Address - Country:US
Practice Address - Phone:850-863-5174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6617235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist