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General NPI Number Information
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NPI Number | 1972376218
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Entity Type | Individual
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Provider Name | MELANIE MARIE MENDOZA BERRIOS B.A.
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Gender | Female
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 222 BROADWAY UNIT 211
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City | KISSIMMEE
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State | FL
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Zip | 34741-5760
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Country | US
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Telephone | 407-329-3464
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Fax | 407-386-3344
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Provider Business Mailing Address
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Address Line | 5969 LEE VISTA BLVD APT 105
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City | ORLANDO
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State | FL
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Zip | 32822-1522
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Country | US
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Telephone | 787-988-0130
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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 | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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