Healthcare Provider Details

I. General information

NPI: 1114848710
Provider Name (Legal Business Name): BIANCA Y MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 W 190TH ST STE 1000
GARDENA CA
90248-4255
US

IV. Provider business mailing address

1002 S GRANDEE AVE APT 4
COMPTON CA
90220-4209
US

V. Phone/Fax

Practice location:
  • Phone: 616-222-5607
  • Fax:
Mailing address:
  • Phone: 323-357-4874
  • 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: