Provider Demographics
NPI:1407560006
Name:MENENDEZ, LIZETT
Entity Type:Individual
Prefix:
First Name:LIZETT
Middle Name:
Last Name:MENENDEZ
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 1:120 NW 87TH AVE APT F204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4545
Mailing Address - Country:US
Mailing Address - Phone:305-244-2493
Mailing Address - Fax:
Practice Address - Street 1:120 NW 87TH AVE APT F204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4545
Practice Address - Country:US
Practice Address - Phone:305-244-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0104984171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator