Provider Demographics
NPI:1255313854
Name:MENDOZA, REGINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:
Last Name:MENDOZA
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 1:1390 S DIXIE HWY
Mailing Address - Street 2:SUITE 1306
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2927
Mailing Address - Country:US
Mailing Address - Phone:305-262-0806
Mailing Address - Fax:
Practice Address - Street 1:1390 S DIXIE HWY
Practice Address - Street 2:SUITE 1306
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2927
Practice Address - Country:US
Practice Address - Phone:305-262-0806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6601103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8656Medicare ID - Type Unspecified