Provider Demographics
NPI:1831105709
Name:MENENDEZ, MARIA L
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:L
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7511 NW 73RD ST
Mailing Address - Street 2:# 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2403
Mailing Address - Country:US
Mailing Address - Phone:305-889-0310
Mailing Address - Fax:305-889-1168
Practice Address - Street 1:7511 NW 73RD ST
Practice Address - Street 2:# 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-2403
Practice Address - Country:US
Practice Address - Phone:305-889-0310
Practice Address - Fax:305-889-1168
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9510311000Medicaid
FL9510311000Medicaid