Healthcare Provider Details

I. General information

NPI: 1265962351
Provider Name (Legal Business Name): DAYLIS MENDEZ RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 NW 179TH ST APT 210
MIAMI FL
33015-5468
US

IV. Provider business mailing address

7130 NW 179TH ST APT 210
MIAMI FL
33015-5468
US

V. Phone/Fax

Practice location:
  • Phone: 786-915-1626
  • Fax:
Mailing address:
  • Phone: 305-591-7898
  • 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: