Provider Demographics
NPI:1124596846
Name:MENDOZA-ORAMA, MARIANYELIS
Entity Type:Individual
Prefix:
First Name:MARIANYELIS
Middle Name:
Last Name:MENDOZA-ORAMA
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 1:2431 BLVD LUIS A FERRE STE 205
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2115
Mailing Address - Country:US
Mailing Address - Phone:787-848-5050
Mailing Address - Fax:
Practice Address - Street 1:2431 BLVD LUIS A FERRE STE 205
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2115
Practice Address - Country:US
Practice Address - Phone:787-848-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7193103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty