Provider Demographics
NPI:1023856390
Name:MENDOZA LOPEZ, NIURKA ANNELYS
Entity type:Individual
Prefix:
First Name:NIURKA ANNELYS
Middle Name:
Last Name:MENDOZA LOPEZ
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 1:1530 SW 2ND ST APT 306
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2171
Mailing Address - Country:US
Mailing Address - Phone:305-989-1187
Mailing Address - Fax:
Practice Address - Street 1:1530 SW 2ND ST APT 306
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2171
Practice Address - Country:US
Practice Address - Phone:305-989-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-355648106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician