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3501 W Vine St Ste 124 Kissimmee FL 34741-4660 | |
| (407) 483-3074 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3501 W Vine St Ste 124, Kissimmee, Florida |
| Authorized Official Name and Position | Isabel N Mendoza (PRESIDENT) |
| Authorized Official Contact | 4074833074 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3501 W Vine St Ste 124 Kissimmee FL 34741-4660 Ph: (407) 483-3074 | 3501 W Vine St Ste 124 Kissimmee FL 34741-4660 Ph: (407) 483-3074 |
| NPI Number | 1235527789 |
|---|---|
| Provider Enumeration Date | 01/07/2015 |
| Last Update Date | 07/21/2022 |
| Certification Date | 04/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235527789 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Florida) | Primary |
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