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General NPI Number Information
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NPI Number | 1801772165
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Entity Type | Individual
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Provider Name | MIREYA MONDRAGON
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Gender | Female
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Dates
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Enumeration Date | 08/13/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 115 K D REVELL RD
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City | WAUCHULA
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State | FL
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Zip | 33873-2051
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Country | US
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Telephone | 863-773-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 2026 CRYSTAL WOOD DR
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City | LAKELAND
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State | FL
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Zip | 33801-6884
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Country | US
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Telephone | 863-709-9392
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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