Provider Demographics
NPI:1568492437
Name:MENDOZA, LUZ MARIA (OT)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:MARIA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14411 COMMERCE WAY STE 230
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1598
Mailing Address - Country:US
Mailing Address - Phone:305-803-3165
Mailing Address - Fax:305-397-1257
Practice Address - Street 1:14411 COMMERCE WAY STE 230
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1598
Practice Address - Country:US
Practice Address - Phone:305-625-8844
Practice Address - Fax:305-995-0906
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6348225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT6348OtherOCC THERAPYST LICENSE
FL887169800Medicaid