Healthcare Provider Details

I. General information

NPI: 1972296309
Provider Name (Legal Business Name): VERONICA ISABEL MENDEZ GARCIA MSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 07/01/2024
Certification Date: 09/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N R ST STE 101
MADERA CA
93637-4465
US

IV. Provider business mailing address

117 N R ST STE 101
MADERA CA
93637-4465
US

V. Phone/Fax

Practice location:
  • Phone: 559-662-0527
  • Fax: 559-661-5159
Mailing address:
  • Phone: 559-662-0527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number115364
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: