Healthcare Provider Details

I. General information

NPI: 1417709973
Provider Name (Legal Business Name): YOEL MENDOZA ROMERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15698 SW 18TH ST
MIAMI FL
33185-5814
US

IV. Provider business mailing address

15698 SW 18TH ST
MIAMI FL
33185-5814
US

V. Phone/Fax

Practice location:
  • Phone: 305-244-2549
  • Fax:
Mailing address:
  • Phone: 305-244-2549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: