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General NPI Number Information
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NPI Number | 1659163541
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Entity Type | Individual
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Provider Name | THALIA BARBARA MENDOZA GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 2160 SW 16TH AVE APT 216
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City | MIAMI
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State | FL
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Zip | 33145-2869
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Country | US
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Telephone | 786-647-6355
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Fax |
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Provider Business Mailing Address
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Address Line | 2160 SW 16TH AVE APT 216
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City | MIAMI
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State | FL
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Zip | 33145-2869
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Country | US
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Telephone | 786-647-6355
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1305835
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License Number State | FL
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