Healthcare Provider Details

I. General information

NPI: 1629298161
Provider Name (Legal Business Name): RAQUEL B MENDEZ CCPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6726 W FLAGLER ST
MIAMI FL
33144-2924
US

IV. Provider business mailing address

458 E 19TH ST
HIALEAH FL
33013-4128
US

V. Phone/Fax

Practice location:
  • Phone: 305-261-9560
  • Fax:
Mailing address:
  • Phone: 305-525-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCI390
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: