Healthcare Provider Details

I. General information

NPI: 1477472785
Provider Name (Legal Business Name): ANDREW BRIAN MENDOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 FULTON ST
FRESNO CA
93721-1610
US

IV. Provider business mailing address

26135 VALERIE AVE
MADERA CA
93638-0226
US

V. Phone/Fax

Practice location:
  • Phone: 888-988-0520
  • Fax:
Mailing address:
  • Phone: 559-474-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: