Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1073063467 |
---|---|
Provider Name | Ivonne Mendez |
First Address | Orlando, FL 32822-4573 |
Second Address | Orlando, FL 32822-4573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2016 |
Last Update Date | 10/10/2016 |