Healthcare Provider Details

I. General information

NPI: 1184530354
Provider Name (Legal Business Name): ANDREW K MENDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DREW MENDEZ

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 BAY BLVD STE B
CHULA VISTA CA
91911-2670
US

IV. Provider business mailing address

3830 FRONT ST APT 5
SAN DIEGO CA
92103-3040
US

V. Phone/Fax

Practice location:
  • Phone: 619-585-7686
  • Fax:
Mailing address:
  • Phone: 925-337-5298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMF164600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: