Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA11060 | FL |
NPI | 1003106055 |
---|---|
Provider Name | Mr. Leonell Leonardo Mendez |
First Address | Miami, FL 33155-2800 |
Second Address | Miami, FL 33155-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2011 |
Last Update Date | 12/04/2011 |