Healthcare Provider Details

I. General information

NPI: 1639008709
Provider Name (Legal Business Name): ANTONIA GABRIELA MENDEZ MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELA MENDEZ MS, CCC-SLP

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 BROADWAY AVE
EL CENTRO CA
92243-2317
US

IV. Provider business mailing address

2051 S FAIRFIELD DR
EL CENTRO CA
92243-9640
US

V. Phone/Fax

Practice location:
  • Phone: 760-562-4924
  • Fax:
Mailing address:
  • Phone: 760-562-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: