Healthcare Provider Details

I. General information

NPI: 1720455108
Provider Name (Legal Business Name): ROSALILIA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 S BASCOM AVE SUITE 100
SAN JOSE CA
95128-2651
US

IV. Provider business mailing address

828 S BASCOM AVE SUITE 100
SAN JOSE CA
95128-2651
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-5959
  • Fax: 408-793-5955
Mailing address:
  • Phone: 408-793-5959
  • Fax: 408-793-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW30436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: