Healthcare Provider Details

I. General information

NPI: 1871967281
Provider Name (Legal Business Name): DEVIN MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7840 MISSION CENTER CT STE #200
SAN DIEGO CA
92108-1319
US

IV. Provider business mailing address

5674 REGIS AVE
SAN DIEGO CA
92120-4824
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-0622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: