Provider Demographics
NPI:1073139879
Name:MENDEZ PORTAL, OLGA MARIA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:MARIA
Last Name:MENDEZ PORTAL
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 1:2436 SW 7TH ST APT 12
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3021
Mailing Address - Country:US
Mailing Address - Phone:305-790-1876
Mailing Address - Fax:
Practice Address - Street 1:2436 SW 7TH ST APT 12
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3021
Practice Address - Country:US
Practice Address - Phone:305-790-1876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician