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General NPI Number Information
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NPI Number | 1538635412
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Entity Type | Individual
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Provider Name | JUDITH GABRIELA MAYORGA
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Gender | Female
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Dates
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Enumeration Date | 10/18/2018
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 10200 NW 25TH ST # A-108
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City | DORAL
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State | FL
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Zip | 33172-5921
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Country | US
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Telephone | 305-767-1924
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Fax |
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Provider Business Mailing Address
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Address Line | 10200 NW 25TH ST # A-108
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City | DORAL
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State | FL
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Zip | 33172-5921
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SI4368
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 18-65482
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License Number State | FL
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