Healthcare Provider Details

I. General information

NPI: 1699210997
Provider Name (Legal Business Name): DANIEL MENDOZA BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2016
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 RANCHO CAMINO DR STE 101-104
POMONA CA
91766-7019
US

IV. Provider business mailing address

PO BOX 740780
ATLANTA GA
30374-0780
US

V. Phone/Fax

Practice location:
  • Phone: 909-326-0662
  • Fax:
Mailing address:
  • Phone: 855-223-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-24542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: