Individual
ADDIS TARRERO MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
24801 SW 130TH AVE APT 302, PRINCETON, FL 33032-4097
(786) 720-1863
Mailing address
24801 SW 130TH AVE APT 302, PRINCETON, FL 33032-4097
(786) 720-1863
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
FL
106S00000X
Behavior Technician
023263900
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023263900
—
FL
Enumeration date
09/20/2018
Last updated
07/01/2020
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