Provider Demographics
NPI:1265962351
Name:MENDEZ RODRIGUEZ, DAYLIS
Entity type:Individual
Prefix:
First Name:DAYLIS
Middle Name:
Last Name:MENDEZ RODRIGUEZ
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 1:7130 NW 179TH ST APT 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5468
Mailing Address - Country:US
Mailing Address - Phone:305-591-7898
Mailing Address - Fax:
Practice Address - Street 1:7130 NW 179TH ST APT 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015-5468
Practice Address - Country:US
Practice Address - Phone:786-915-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician