Healthcare Provider Details

I. General information

NPI: 1750293775
Provider Name (Legal Business Name): SIMON MATT MENDEZ CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 ATLANTIC AVE STE 102
LONG BEACH CA
90807-3535
US

IV. Provider business mailing address

15902 SWEET PL
HACIENDA HEIGHTS CA
91745-3528
US

V. Phone/Fax

Practice location:
  • Phone: 562-471-7710
  • Fax:
Mailing address:
  • Phone: 626-543-5713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: