MEDICARE: PATRICIA MARIA MENDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	R1251270517	CA

General Provider Information

NPI Number	:	1558880450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MARIA MENDEZ

Provider Business Mailing Address
First Line	:	16808 MAIN ST
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92345-7922
Country	:	US
Telephone Number	:	213-985-8573
Fax Number	:

Provider Business Practice Location Address
First Line	:	6180 LAUREL CANYON BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3231
Country	:	US
Telephone Number	:	818-985-0560
Fax Number	:	818-985-7193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	09/12/2017

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Directions to “ PATRICIA MARIA MENDEZ ” Practice Location

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