Provider Demographics
NPI:1710120076
Name:MEJIA-PLATA, LUZ ADRIANA (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LUZ
Middle Name:ADRIANA
Last Name:MEJIA-PLATA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:ADRIANA
Other - Last Name:MEJIA-PLATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:9710 DARLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5800
Mailing Address - Country:US
Mailing Address - Phone:917-804-5551
Mailing Address - Fax:
Practice Address - Street 1:53 ASH DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-1102
Practice Address - Country:US
Practice Address - Phone:561-767-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008479500Medicaid