Provider Demographics
NPI:1497187066
Name:ALMANZAR-MENDEZ, RAFAELINA (MED)
Entity Type:Individual
Prefix:
First Name:RAFAELINA
Middle Name:
Last Name:ALMANZAR-MENDEZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 IRVING AVE
Mailing Address - Street 2:P.S. 123
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-2952
Mailing Address - Country:US
Mailing Address - Phone:917-767-6219
Mailing Address - Fax:
Practice Address - Street 1:100 IRVING AVE
Practice Address - Street 2:P.S. 123
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-2952
Practice Address - Country:US
Practice Address - Phone:917-767-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04304514Medicaid