Healthcare Provider Details

I. General information

NPI: 1497660831
Provider Name (Legal Business Name): TERESA MENDOZA MUWWAKKIL WELLNESS COACH II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 E 8TH ST
BEAUMONT CA
92223-2416
US

IV. Provider business mailing address

1378 SAN MIGUEL DR
BEAUMONT CA
92223-1530
US

V. Phone/Fax

Practice location:
  • Phone: 909-486-9782
  • Fax:
Mailing address:
  • Phone: 909-486-9782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number8E3990A334
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: