Healthcare Provider Details

I. General information

NPI: 1710776596
Provider Name (Legal Business Name): JOSSIE SARAI MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41307 12TH ST W STE 4130712
PALMDALE CA
93551-1445
US

IV. Provider business mailing address

41307 12TH ST W STE 105
PALMDALE CA
93551-1454
US

V. Phone/Fax

Practice location:
  • Phone: 661-575-8395
  • Fax:
Mailing address:
  • Phone: 661-575-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: