Healthcare Provider Details

I. General information

NPI: 1073139879
Provider Name (Legal Business Name): OLGA MARIA MENDEZ PORTAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 SW 7TH ST APT 12
MIAMI FL
33135-3021
US

IV. Provider business mailing address

2436 SW 7TH ST APT 12
MIAMI FL
33135-3021
US

V. Phone/Fax

Practice location:
  • Phone: 305-790-1876
  • Fax:
Mailing address:
  • Phone: 305-790-1876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: