Provider Demographics
NPI:1205324779
Name:MENDEZ AMADOR, TANIA DELA CARIDAD
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:DELA CARIDAD
Last Name:MENDEZ AMADOR
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 1:3995 SW 108TH AVE APT 46
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4458
Mailing Address - Country:US
Mailing Address - Phone:786-443-0786
Mailing Address - Fax:
Practice Address - Street 1:3995 SW 108TH AVE APT 46
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4458
Practice Address - Country:US
Practice Address - Phone:786-443-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician