MEDICARE: MELISA MENDEZ GONZALEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-25-407085	FL

General Provider Information

NPI Number	:	1952192171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISA MENDEZ GONZALEZ

Provider Business Mailing Address
First Line	:	43 W 4TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4706
Country	:	US
Telephone Number	:	786-561-5882
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 W 4TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-4706
Country	:	US
Telephone Number	:	786-561-5882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/15/2025

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