Healthcare Provider Details

I. General information

NPI: 1770416901
Provider Name (Legal Business Name): IRISBEL MENA RODRIGUEZ SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 SW 67TH AVE
MIAMI FL
33144-4714
US

IV. Provider business mailing address

1135 THRUSH AVE
MIAMI SPRINGS FL
33166-3150
US

V. Phone/Fax

Practice location:
  • Phone: 786-630-7366
  • Fax:
Mailing address:
  • Phone: 786-923-6478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI7632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: