Healthcare Provider Details

I. General information

NPI: 1437085347
Provider Name (Legal Business Name): HECTOR ETHAN MENDOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39210 STATE ST STE 100
FREMONT CA
94538-1456
US

IV. Provider business mailing address

16750 MAYALL ST
NORTH HILLS CA
91343-1038
US

V. Phone/Fax

Practice location:
  • Phone: 510-451-2000
  • Fax:
Mailing address:
  • Phone: 510-451-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: