Healthcare Provider Details

I. General information

NPI: 1649052291
Provider Name (Legal Business Name): NOEMY ISEL MENDOZA M.S., ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 N CEDAR AVE STE 102
FRESNO CA
93720-2693
US

IV. Provider business mailing address

1926 CHERRY AVE
SANGER CA
93657-3702
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-2322
  • Fax:
Mailing address:
  • Phone: 559-270-4761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: