Provider Demographics
NPI:1437940095
Name:MENDEZ GREGORIO, OMAR IV (RBT)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:MENDEZ GREGORIO
Suffix:IV
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 WINDMILL GATE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6042
Mailing Address - Country:US
Mailing Address - Phone:561-759-0849
Mailing Address - Fax:
Practice Address - Street 1:6408 WINDMILL GATE RD
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6042
Practice Address - Country:US
Practice Address - Phone:561-759-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-436255106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician