Healthcare Provider Details

I. General information

NPI: 1922896745
Provider Name (Legal Business Name): JENNIFER MENDEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 W TEFFT ST
NIPOMO CA
93444-9624
US

IV. Provider business mailing address

602 ORCHARD AVE
ARROYO GRANDE CA
93420-4000
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-3790
  • Fax:
Mailing address:
  • Phone: 805-474-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: