Healthcare Provider Details

I. General information

NPI: 1831046879
Provider Name (Legal Business Name): CRYSTAL MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 N FRESNO ST STE 103
FRESNO CA
93710-6875
US

IV. Provider business mailing address

350 FAIRWAY DR STE 101
DEERFIELD BCH FL
33441-1834
US

V. Phone/Fax

Practice location:
  • Phone: 550-505-8290
  • Fax:
Mailing address:
  • Phone: 550-505-8290
  • 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: