Healthcare Provider Details

I. General information

NPI: 1043609787
Provider Name (Legal Business Name): MICHELLE MENDOZA CASTILLO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE MENDOZA

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD STE 110
HAWAIIAN GARDENS CA
90716-2604
US

IV. Provider business mailing address

16115 HALDANE ST
WHITTIER CA
90603-2815
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax:
Mailing address:
  • Phone: 626-541-2671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number82629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: