Healthcare Provider Details

I. General information

NPI: 1477920494
Provider Name (Legal Business Name): JOANNA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 01/03/2022
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 BISSO LN SUITE 200
CONCORD CA
94520-4897
US

IV. Provider business mailing address

3454 HILLCREST AVE
ANTIOCH CA
94531-8238
US

V. Phone/Fax

Practice location:
  • Phone: 925-642-1141
  • Fax:
Mailing address:
  • Phone: 925-777-6303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number30948
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: