Healthcare Provider Details

I. General information

NPI: 1831969476
Provider Name (Legal Business Name): MARIA ROQUE MENENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 NW 82ND AVE
DORAL FL
33126-1011
US

IV. Provider business mailing address

6361 SW 138TH PL
MIAMI FL
33183-1162
US

V. Phone/Fax

Practice location:
  • Phone: 786-420-5924
  • Fax: 786-542-5340
Mailing address:
  • Phone: 786-337-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: