Provider Demographics
NPI:1770182503
Name:MENDICOCHEA, MIDALYS (RBT)
Entity Type:Individual
Prefix:
First Name:MIDALYS
Middle Name:
Last Name:MENDICOCHEA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18121 SW 139TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2790
Mailing Address - Country:US
Mailing Address - Phone:305-744-4456
Mailing Address - Fax:
Practice Address - Street 1:4830 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6426
Practice Address - Country:US
Practice Address - Phone:305-515-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-139440106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician