Provider Demographics
NPI:1801179585
Name:MENDEZ, MARIELENA (CSA)
Entity Type:Individual
Prefix:
First Name:MARIELENA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23111 SW 54TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7933
Mailing Address - Country:US
Mailing Address - Phone:954-461-4851
Mailing Address - Fax:
Practice Address - Street 1:1012 S 12TH ST
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-4432
Practice Address - Country:US
Practice Address - Phone:561-436-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3692246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant