Healthcare Provider Details

I. General information

NPI: 1750290144
Provider Name (Legal Business Name): DAVID MENDOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 HAZELWOOD WAY
EAST PALO ALTO CA
94303-1101
US

IV. Provider business mailing address

2528 HAZELWOOD WAY
EAST PALO ALTO CA
94303-1101
US

V. Phone/Fax

Practice location:
  • Phone: 650-471-5775
  • Fax:
Mailing address:
  • Phone: 650-471-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1107852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: