Healthcare Provider Details

I. General information

NPI: 1447827332
Provider Name (Legal Business Name): ALYSSA CARLEEN MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 ADELINE ST
BERKELEY CA
94703-2407
US

IV. Provider business mailing address

340 ALTA VISTA AVE APT 6
OAKLAND CA
94610-1950
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-0203
  • Fax:
Mailing address:
  • Phone: 213-453-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: