Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | MA60770 | FL |
NPI | 1174826267 |
---|---|
Provider Name | Yaqueline Mena |
First Address | Doral, FL 33126-1827 |
Second Address | Doral, FL 33126-1827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2010 |
Last Update Date | 10/12/2010 |