Individual
JUDITH GABRIELA MAYORGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10200 NW 25TH ST # A-108, DORAL, FL 33172-5921
(305) 767-1924
Mailing address
10200 NW 25TH ST # A-108, DORAL, FL 33172-5921
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
18-65482
FL
2355S0801X
Speech-Language Assistant
Primary
SI4368
FL
Other
Enumeration date
10/18/2018
Last updated
12/30/2020
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