Provider Demographics
NPI:1831922616
Name:MENDEZ FERNANDEZ, BERTHA CARMELINA
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:CARMELINA
Last Name:MENDEZ FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 PARSONS RESERVE CT
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-5779
Mailing Address - Country:US
Mailing Address - Phone:786-720-0534
Mailing Address - Fax:
Practice Address - Street 1:606 PARSONS RESERVE CT
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-5779
Practice Address - Country:US
Practice Address - Phone:786-720-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-356271106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician