Provider Demographics
NPI:1578310645
Name:MENDEZ RECIO, DARIEL
Entity type:Individual
Prefix:
First Name:DARIEL
Middle Name:
Last Name:MENDEZ RECIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 NE 8TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-3349
Mailing Address - Country:US
Mailing Address - Phone:786-308-8581
Mailing Address - Fax:
Practice Address - Street 1:3244 NE 8TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-3349
Practice Address - Country:US
Practice Address - Phone:786-308-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-337460106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician