Organization Active NPI

Mendoza Behavioral Health LLC

  • Psychiatry Physician
  • Daytona Beach, FL
National Provider Identifier
1295262137
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
ACN216 Issued in FL
Legal business name
MENDOZA BEHAVIORAL HEALTH LLC
Practice address
110 Orange Ave
Daytona Beach, FL 32114-4310
Phone
(386) 256-4326
NPI assigned
May 22, 2017
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Liana Mendoza, MDNPI 1750585139
Title
Psychiatrist
Phone
(386) 254-2637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory

Locations

110 Orange Ave
Daytona Beach, FL 32114
Phone (386) 256-4326

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X ACN216 FL Primary

Addresses

NPPES NPI Registry

Primary practice location

110 Orange Ave
Daytona Beach, FL 32114-4310

Mailing address

110 Orange Ave
Daytona Beach, FL 32114-4310

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
280152300MedicaidFL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 11, 2019.

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1295262137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ORANGE AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321144310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 ORANGE AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321144310",
            "telephone_number": "386-256-4326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOZA BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-22",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "LIANA",
        "authorized_official_title_or_position": "PSYCHIATRIST",
        "authorized_official_telephone_number": "386-254-2637",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ACN216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "280152300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.