Provider Demographics
NPI:1275154130
Name:MENDOZA, XIOMARA C
Entity Type:Individual
Prefix:
First Name:XIOMARA
Middle Name:C
Last Name:MENDOZA
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 1:10236 BOCA ENTRADA BLVD APT 117
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5819
Mailing Address - Country:US
Mailing Address - Phone:561-803-5003
Mailing Address - Fax:
Practice Address - Street 1:10236 BOCA ENTRADA BLVD APT 117
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5819
Practice Address - Country:US
Practice Address - Phone:561-803-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional