Provider Demographics
NPI:1629298161
Name:MENDEZ, RAQUEL B (CCPA)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:B
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:CCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-4128
Mailing Address - Country:US
Mailing Address - Phone:305-525-7190
Mailing Address - Fax:
Practice Address - Street 1:6726 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2924
Practice Address - Country:US
Practice Address - Phone:305-261-9560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCI390111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation