Healthcare Provider Details

I. General information

NPI: 1366841975
Provider Name (Legal Business Name): MRS. GABRIELA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 CARLOTTA DR
CONCORD CA
94519-1358
US

IV. Provider business mailing address

1936 CARLOTTA DR
CONCORD CA
94519-1358
US

V. Phone/Fax

Practice location:
  • Phone: 925-682-8000
  • Fax:
Mailing address:
  • Phone: 925-682-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: